CN104334096B - Include the tissue thickness compensation part of multiple capsules - Google Patents

Abstract

The invention discloses a kind of tissue thickness compensation part (21020), the tissue thickness compensation part may include multiple layers.Disclosed herein is the various embodiments for manufacturing tissue thickness compensation part.In certain embodiments, tissue thickness compensation part may include at least one medication tube, capsule and/or the package being included in.

Description

Include the tissue thickness compensation part of multiple capsules

The cross reference of related application

The patent application of this non-transitory be according to 35U.S.C. § 120 Septembers in 2010 submit within 30th it is entitled " Fastener System Comprising A Retention Matrix And A Cover " U.S. Patent Application Serial Numbers 12/894,388 part continuation application, the complete disclosure of the patent application is herein incorporated by reference.

Background technology

The present invention relates to surgical instruments, and in various embodiments, the present invention relates to be designed to cut and stitch The charge-coupled surgery cuts knitted and suture instruments and its nail bin.

The content of the invention

The following is the incomplete row of claimed or possible claimed invention embodiment Table.

1. a kind of method for manufacturing tissue thickness compensation part, including：

Preparation includes the solution of hydrophilic material；

Medicine is dissolved in the solution；

The solution is mixed with hydrophobic material；

The solution is poured into mould；And

Freeze the solution.

2. the method according to embodiment 1, wherein lyophilized include placing mould in a vacuum chamber, reduces the vacuum Temperature in indoor air pressure, and the reduction vacuum chamber.

3. the method according to embodiment 1 or embodiment 2, wherein lyophilized produce material piece, and wherein methods described Also include shredding the material piece.

4. the method according to any one of embodiment 1-3, wherein the medicine is dissolved into particulate in the solution.

5. the method according to embodiment 4, wherein after solution and hydrophobic material mixing, particle suspension is in hydrophobic In property material.

6. a kind of tissue thickness compensation part being used together with fastening instrument, the tissue thickness compensation part includes：

The compressible stratum that can be captured at least in part by fastener；And

It is embedded in multiple capsules in compressible stratum.

7. the tissue thickness compensation part according to embodiment 6, wherein fastening instrument include anvil block, and wherein organize thick Degree compensating part includes that the attachment part of anvil block can be attached to.

8. the tissue thickness compensation part according to embodiment 6 or embodiment 7, wherein compressible stratum, which include tissue, contacts table Face, and wherein capsule is embedded in tissue contacting surface.

9. the tissue thickness compensation part according to any one of embodiment 6-8, wherein each capsule includes easy broken shell Body.

10. the tissue thickness compensation part according to any one of embodiment 6-9, wherein the multiple capsule includes the One capsule and the second capsule, wherein the first capsule includes the first medicine, and wherein the second capsule includes being different from Second medicine of the first medicine.

11. the tissue thickness compensation part according to embodiment 10, wherein the first capsule and the second capsule are with alternately Arrange along paths arrangement.

12. the tissue thickness compensation part according to embodiment 10 or embodiment 11, wherein compressible stratum are included from capsule The passage of agent extension, and wherein described passage can convey the first medicine and the second medicine.

13. the tissue thickness compensation part according to embodiment 12, wherein anvil block include multiple grooves, and wherein each Groove can receive at least one in the capsule.

14. a kind of nail bin, including：

Warehouse, the warehouse includes the nail cavity limited in platform and the platform；

Nail, wherein each nail is positioned at least partially in one in the nail cavity, and wherein described nail can be not Moved between firing position and firing position；

Compressible tissue thickness compensation part, wherein nail is extended at least partly into tissue thickness compensation part, and its Middle nail can capture tissue thickness compensation part at least in part when being moved between non-firing position and firing position；And

Substrate, the substrate is positioned between tissue thickness compensation part and platform.

15. the nail bin according to embodiment 14, wherein substrate include multiple sealed tubes, the sealed tube includes wherein Medicine.

16. the nail bin according to embodiment 15, wherein sealed tube are aligned with nail.

17. the nail bin according to embodiment 15, its middle warehouse also includes that the slit of cutting element can be received, wherein sealing Stopped pipe extends on slit, and wherein sealed tube can be cut the medicine that component cutting is wherein included to discharge.

18. the nail bin according to embodiment 17, wherein each sealed tube extends along pipe axis, and wherein every pipe axle Line is upwardly extended in the side transverse to slit.

19. the nail bin according to any one of embodiment 15-18, wherein medicine include fluid.

20. the nail bin according to any one of embodiment 14-19, wherein each nail includes at least one nail leg, its Middle substrate includes multiple holes, and wherein some or all of nail leg extends through the hole.

21. the nail bin according to any one of embodiment 14-20, wherein compressible Tissue compensating part is attached to base Bottom.

Brief description of the drawings

By referring to the following explanation of the embodiment of the present invention, feature of the invention and advantage and its acquisition side with reference to accompanying drawing Method will become more apparent, and be better understood invention in itself, wherein：

Fig. 1 is the sectional view of surgical instrument embodiment；

Figure 1A is the perspective view of one embodiment of implanted nail bin；

Figure 1B -1E show some for the end effector that tissue is clamped and sutured with implanted nail bin；

Fig. 2 is the partial cross-sectional side view of another end effector of the part for being connected to surgical instruments, wherein End effector supports surgery nail bin and its anvil block is in an open position；

Fig. 3 is end effector shown in Fig. 2 another partial cross-sectional side view in the close position；

Fig. 4 is that the end effector shown in Fig. 2 and Fig. 3 begins to pass another local horizontal stroke when end effector is promoted in knife bar Side cross-sectional view；

Fig. 5 is that the end effector shown in Fig. 2 to Fig. 4 is another local horizontal when knife bar is partly advanced through wherein Side cross-sectional view；

Fig. 6 A-6D describe the deformation for the surgical staples being positioned at according at least one embodiment in staple cartridge body；

Fig. 7 A are the schematic diagrames for showing to be positioned at nail that can be in conquassation staple cartridge body；

Fig. 7 B be show Fig. 7 A can conquassation staple cartridge body by the schematic diagram of anvil block conquassation；

Fig. 7 C be show Fig. 7 A can conquassation staple cartridge body by the schematic diagram of the further conquassation of anvil block；

Fig. 7 D be show Fig. 7 A nail in be fully formed configuration and Fig. 7 A can conquassation nail bin be in complete conquassation situation Schematic diagram；

Fig. 8 is the top view of the nail bin according at least one embodiment, and the nail bin is included in embedded staple cartridge body Nail；

Fig. 9 is the front view of Fig. 8 nail bin；

Figure 10 is the decomposition diagram of the alternative embodiment of compressible nail bin, and the compressible nail bin includes following closely and used In the system for driving nail against anvil block；

Figure 10 A are the part sectioned views of the alternative embodiment of Figure 10 nail bin；

Figure 11 is the profile of Figure 10 nail bin；

Figure 12 is can to traverse Figure 10 nail bin and make the front view for the sliding part that nail moves towards anvil block；

Figure 13 is the schematic diagram for the staple drivers that can be lifted by Figure 12 sliding part towards anvil block；

Figure 14 is the perspective view of the nail bin of at least one embodiment according to the present invention, and nail bin includes and surgery suturing appliance The rigid support portion and compressible tissue thickness compensation part being used together；

Figure 15 is the partial exploded view of Figure 14 nail bin；

Figure 16 is the complete exploded view of Figure 14 nail bin；

Figure 17 is another exploded view of Figure 14 nail bin, and the nail bin is not covered with the wrappage of tissue thickness compensation part；

Figure 18 is the warehouse of Figure 14 nail bin or the perspective view of support section；

Figure 19 is the top perspective of sliding part, and the sliding part can be moved in Figure 14 nail bin, with from cartridge deployment Nail；

Figure 20 is the bottom perspective view of Figure 19 sliding part；

Figure 21 is the front view of Figure 19 sliding part；

Figure 22 is the top perspective of driver, and the driver can support one or more nails, and by Figure 19 slip Part is lifted up projecting nail from nail bin；

Figure 23 is the bottom perspective view of Figure 22 driver；

Figure 24 be can at least partly around the compressible tissue thickness compensation part of nail bin wrappage；

Figure 25 is the part sectioned view of nail bin, and nail bin includes rigid support portion and compressible tissue thickness compensation part, Show that never firing position moves to firing position to nail during First ray；

Figure 26 is the front view of Figure 25 nail bin；

Figure 27 is the thin portion front view of Figure 25 nail bin；

Figure 28 is the section end view of Figure 25 nail bin；

Figure 29 is the bottom view of Figure 25 nail bin；

Figure 30 is the thin portion bottom view of Figure 25 nail bin；

Figure 31 is the longitudinal sectional drawing of anvil block in the close position and nail bin, and nail bin includes rigid support portion and can pressed The tissue thickness compensation part of contracting, shows that never firing position moves to firing position to nail during First ray；

Figure 32 is Figure 31 anvil block and another profile of nail bin, is shown after percussion sequence is completed in opening The anvil block of position；

Figure 33 is the local detail drawing of Figure 31 nail bin, shows the nail in non-firing position；

Figure 34 is the cross-section front view of nail bin, and the nail bin includes rigid support portion and compressible tissue thickness compensates Part, shows the nail in non-firing position；

Figure 35 is the detail drawing of Figure 34 nail bin；

Figure 36 is the front view of anvil block in an open position and nail bin, and nail bin includes rigid support portion and compressible Tissue thickness compensation part, shows the nail in non-firing position；

Figure 37 is the front view of anvil block in the close position and nail bin, and nail bin includes rigid support portion and compressible Tissue thickness compensation part, shows the nail in non-firing position and is trapped between anvil block and tissue thickness compensation part Tissue；

Figure 38 is Figure 37 anvil block and the detail drawing of nail bin；

Figure 39 is the front view of anvil block in the close position and nail bin, and nail bin includes rigid support portion and compressible Tissue thickness compensation part, shows the nail in non-firing position, show be positioned in it is thicker between anvil block and nail bin Tissue；

Figure 40 is Figure 39 anvil block and the detail drawing of nail bin；

Figure 41 is Figure 39 anvil block and the front view of nail bin, shows to be positioned between anvil block and nail bin have difference The tissue of thickness；

Figure 42 is Figure 39 anvil block and the detail drawing of nail bin, as shown in figure 41；

Figure 43 is to show the tissue thickness compensation part compensated to the different tissues thickness being trapped in different nails Schematic diagram；

Figure 44 is to show that tissue thickness compensation part applies compression pressure to by one or more crosscutting blood vessel of staple line Schematic diagram；

Figure 45 is the schematic diagram for being shown in which one or more situations followed closely and do not shaped appropriately；

Figure 46 is the schematic diagram for showing the tissue thickness compensation part that can compensate for imappropriate forming nail；

Figure 47 is the schematic diagram for showing the tissue thickness compensation part being positioned in the intersecting tissue regions of multiple staple lines；

Figure 48 is the schematic diagram for showing the tissue being trapped in nail；

Figure 49 is to show the tissue being trapped in nail and the schematic diagram of tissue thickness compensation part；

Figure 50 is the schematic diagram for showing the tissue being trapped in nail；

Figure 51 is the schematic diagram for showing the thick tissue being trapped in nail and tissue thickness compensation part；

Figure 52 is to show the thin tissue being trapped in nail and the schematic diagram of tissue thickness compensation part；

Figure 53 is the signal for showing the tissue with interior thickness being trapped in nail and tissue thickness compensation part Figure；

Figure 54 is to show the tissue with another interior thickness being trapped in nail and tissue thickness compensation part Schematic diagram；

Figure 55 is the schematic diagram for showing the thick tissue being trapped in nail and tissue thickness compensation part；

Figure 56 is the part sectioned view of the end effector of surgery suturing appliance, is shown in retraction, non-firing position Trigger shaft and nail percussion sliding part；

Figure 57 is another part sectioned view of Figure 56 end effector, shows the percussion in local propulsion position Bar and nail percussion sliding part；

Figure 58 is the profile of Figure 56 end effector, show in be fully advanced or firing position trigger shaft；

Figure 59 is the profile of Figure 56 end effector, show after being fired in advanced position trigger shaft, And stay in the nail percussion sliding part of its complete firing position；

Figure 60 is the detail drawing of Figure 59 trigger shaft in advanced position；

Figure 61 is the profile perspective of the embodiment of cutting blade, end effector of the cutting blade in surgical instruments It is interior to promote to cut tissue towards distal side；

Figure 62 is the cross sectional side view for showing the structure on Figure 61 cutting blade, and the structure can mend tissue thickness The court of the material in part is repaid to guide；

Figure 63 is the profile perspective of the alternative embodiment of cutting blade, and the cutting blade is in the end of surgical instruments Promote to cut tissue towards distal side in actuator；

Figure 64 is the profile perspective of another alternative embodiment of cutting blade, and the cutting blade is in surgical instruments Promote to cut tissue towards distal side in end effector；

Figure 65 is the cross sectional side view for showing the structure on Figure 64 cutting blade, and the structure can be thick by the first tissue The material spent in compensating part and the material mixing from minor microstructure thickness compensation part；

Figure 66 is the front view for showing the structure on Figure 64 cutting blade, and the structure can mend the first tissue thickness Repay the material in part and the material mixing from minor microstructure thickness compensation part；

Figure 67 is the sectional top view for showing the structure on Figure 64 cutting blade, and the structure can be thick by the first tissue The material spent in compensating part and the material mixing from minor microstructure thickness compensation part；

Figure 68 is the profile perspective of another alternative embodiment of cutting blade, and the cutting blade is in surgical instruments Promote to cut tissue towards distal side in end effector；

Figure 69 is the cross sectional side view for showing the structure on Figure 68 cutting blade, and the structure can spread tissue thickness The material included in compensating part；And

Figure 70 is the cross sectional side view of the cutting blade for the Figure 68 for spreading material.

Figure 71 is the perspective cutaway view of the tissue thickness compensation part according at least one embodiment；

Figure 72 shows that medicine is just loaded into tissue thickness compensation part；

Figure 73 is located at the section end view of the pipe in Figure 71 tissue thickness compensation part, and the pipe includes contained therein Medicine；

Figure 74 shows Figure 71 tissue thickness compensation part just against the tissue positioning and compression of patient；

Figure 75 is the section end view of the end effector of surgery suturing appliance, shows to follow closely and is just fired group through Figure 71 Knit thickness compensation part；

Figure 76 is the curve map of the dissolving of capsule for showing to include in tissue thickness compensation part, and wherein capsule is comprising more Individual medicine layer；

Figure 77 shows that the first layer or outer layer of Figure 76 capsule are just dissolved；

Figure 78 shows that the second layer of Figure 76 capsule is just dissolved；

Figure 79 shows that the third layer of Figure 76 capsule is just dissolved；

Figure 80 shows the 4th layer of Figure 76 capsule or internal layer is just dissolved；

Figure 81 is to include the nail bin according at least one embodiment of the tissue thickness compensation part containing multiple vertical capsules Part sectioned view；

Figure 82 is the perspective view of Figure 81 vertical capsule；

Figure 83 is the part sectioned view of Figure 81 nail bin, is shown in which the nail in non-firing position included；

Figure 84 is the cross sectional side view of Figure 81 nail bin, shows that just never firing position moves to percussion position for Figure 83 nail Put；

Figure 85 is to include the tissue thickness compensation part of the vertical capsule wherein positioned according at least one embodiment Part sectioned view；

Figure 86 is to include the part section of the tissue thickness compensation part with the multiple capsules for being defined in opening therein Figure；

Figure 87 is the section end view of the end effector of the surgery suturing appliance according at least one embodiment, the end Portion's actuator includes the capsule or pipe for being in multiple nails of non-firing position and can making to include in tissue thickness compensation part Multiple puncture members of rupture；

Figure 88 is the front view of the nail of Figure 87 in non-percussion configuration；

Figure 89 is the front view of the nail of Figure 88 in percussion configuration；

Figure 90 is the front view of Figure 87 puncture member；

Figure 91 is the section end view of Figure 87 end effector, shows nail and puncture member in firing position；

Figure 92 is the cross sectional side view of Figure 87 end effector, and showing nail and puncture member, just never firing position is transported Move firing position；

Figure 93 is the tissue thickness compensation part of multiple capsules that includes wherein positioning according at least one embodiment The top-sectional view of nail bin；

Figure 94 is the detail drawing of Figure 93 nail bin；

Figure 95 is located at the section end view of the nail bin of Figure 93 in end effector, shows and is contained in nail bin Nail in firing position；

Figure 96 is the section end view of the nail bin of Figure 93 in Figure 95 end effector, shows that cutting element is just pushed away Enter through the capsule in tissue thickness compensation part；

Figure 97 is the perspective view of the tissue thickness compensation part including longitudinal member according at least one embodiment；

Figure 98 is the profile of the mould for the tissue thickness compensation part that can prepare Figure 97；

Figure 99 is the section end view of Figure 98 mould, shows the longitudinal member for being positioned at Figure 97 therein；

Figure 100 is the section end view of Figure 98 mould, shows that tissue thickness compensation part material is just poured into Figure 98 Mould in；

Figure 101 is the profile perspective of the tissue thickness compensation part according at least one embodiment；

Figure 102 is the perspective of the supporting member that can be embedded in tissue thickness compensation part according at least one embodiment Figure；

Figure 103 is the profile perspective of the tissue thickness compensation part according at least one embodiment；

Figure 104 is the section end view for the mould for showing the tissue thickness compensation part for manufacturing Figure 103；

Figure 105 is the profile of Figure 103 tissue thickness compensation part；

Figure 106 is the cross sectional side view of Figure 104 mould；

Figure 107 is the section end view of the tissue thickness compensation part according at least one embodiment；

Figure 108 is the section end view of another tissue thickness compensation part according at least one embodiment；

Figure 109 is the detail drawing of the timbering material of the tissue thickness compensation part according at least one embodiment；

Figure 110 is the detail drawing of the tissue thickness compensation part in non-extended mode according at least one embodiment；

Figure 111 is the detail drawing of the tissue thickness compensation part of Figure 110 in extended mode；

Figure 112 is the profile perspective of the tissue thickness compensation part according at least one embodiment；

Figure 113 is saturating according to the part section of the tissue thickness compensation part just manufactured in a mold of at least one embodiment View；

Figure 114 is the profile perspective of the tissue thickness compensation part according at least one alternative embodiment；

Figure 115 is the section end view of the tissue thickness compensation part according at least one alternative embodiment；

Figure 116 is the fragmentary, perspective view of the tissue thickness compensation part according at least one alternative embodiment；

Figure 117 is performed according to the end of the surgery suturing appliance including tissue thickness compensation part of at least one embodiment The front view of device；

Figure 118 is the exploded view of Figure 117 tissue thickness compensation part, and wherein tissue thickness compensation part includes multiple layers；

Figure 119 is one layer of profile of tissue thickness compensation part；

Figure 120 is another layer of profile of tissue thickness compensation part；

Figure 121 is located at the office of the tissue thickness compensation part of Figure 117 between the anvil block of surgery suturing appliance and nail bin Portion's cross-section front view；

Figure 122 is another part section front view of Figure 117 tissue thickness compensation part, the tissue thickness compensation part quilt Capture is deformed in the nail projected from nail bin and by the anvil block of surgery suturing appliance；

Figure 123 be another part section of the tissue thickness compensation part for Figure 117 that tissue is attached to by Figure 122 nail just View；

Figure 124 is one layer of perspective view of the tissue thickness compensation part according at least one alternative embodiment；

Figure 125 is the saturating of the end effector of the surgery suturing appliance for the tissue thickness compensation part for including the layer containing Figure 124 View；

Figure 126 is the fragmentary, perspective view of the tissue thickness compensation part according at least one alternative embodiment；

Figure 127 is the perspective view of the end effector of the surgery suturing appliance for the tissue thickness compensation part for including Figure 126；

Figure 128 is the perspective view of many coated fibers；

Figure 129 is perspective view, show for prepare coated fiber and/or can be cut into coated fiber coating strand squeeze Go out technique；

Figure 130 is the profile perspective of coated fiber；

Figure 131 is perspective view, show using material can be deposited on fiber and/or within carrying object painting Cloth technique；

Figure 132 is the perspective view of the nail bin for the tissue thickness compensation part for including the fiber containing Figure 128；

Figure 133 is the perspective cutaway view of the tissue thickness compensation part according at least one embodiment；

Figure 134 is the profile of the medicine encapsulated by hydrophilic material according at least one embodiment；

Figure 135 is located at the perspective view of the tissue thickness compensation part of Figure 133 in the end effector of surgical instruments；

Figure 136 is the perspective cutaway view of Figure 134 medicine, and the medicine just enables medicine to ooze exposed to liquid Go out Figure 133 tissue thickness compensation part；

Figure 137 is the fragmentary, perspective view of the tissue thickness compensation part according at least one embodiment；

Figure 138 is Figure 137 tissue thickness compensation part in the fragmentary, perspective view after liquid；

Figure 139 is the perspective view for including being attached to the end effector of Figure 137 of anvil block tissue thickness compensation part；

Figure 140 is the perspective cutaway view of the tissue thickness compensation part of the fiber of the medicine and Figure 128 that include Figure 134；

Figure 141 is the fragmentary, perspective view for the nail bin for including the tissue thickness compensation part containing multiple capsules；

Figure 142 is the side view of Figure 141 nail bin；

Figure 143 shows that Figure 141 capsule is just being placed in a mold；

Figure 144 shows that Figure 141 capsule falls to the bottom of Figure 143 mould；

Figure 145 shows that compensating part material of main part is just poured into above Figure 141 capsule；

Figure 146 shows that wherein Figure 141 capsule is bigger than compensating part material of main part density and is retained in Figure 143 mould Bottom on embodiment；

Figure 147 shows that wherein Figure 141 capsule is smaller than compensating part material of main part density and can float to Figure 143's The embodiment at the top of mould；

Figure 148 shows the alternative embodiment of mould, and the mould includes the multiple recessed of the capsule that can receive Figure 141 Groove or scrobicula；

Figure 149 is the section end view of the end effector of the surgery suturing appliance according at least one embodiment, described End effector includes being positioned at the tissue thickness compensation part above nail bin；

Figure 150 is the section end view of Figure 149 end effector, shows that nail fires from nail bin and extends through figure 149 tissue thickness compensation part；

Figure 151 shows mould and the multiple medicine capsules being positioned in mould；

Figure 152 is the section end view of mould, shows that compensating part material of main part is just being poured into mould with formation group Knit thickness compensation part；

Figure 153 is attached to the perspective view of Figure 152 of the anvil block of surgery suturing appliance tissue thickness compensation part；

Figure 154 is the profile of the mould for the tissue thickness compensation part that can form Figure 157, shows that first layer is just inclined Note in mould；

Figure 155 is the profile of Figure 154 mould, shows the capsule of positioning on the first layer；

Figure 156 is the profile of Figure 154 mould, shows that the second layer is just poured into capsule；

Figure 157 is the perspective view of the tissue thickness compensation part according at least one embodiment；

Figure 158 is located at the perspective of the tissue thickness compensation part of Figure 157 in the end effector of surgery suturing appliance Figure；

Figure 159 is the perspective view of the compensating part main body of Figure 162 tissue thickness compensation part；

Figure 160 is the perspective view for the longitudinal hole being defined in Figure 159 compensating part main body；

Figure 161 is to show the schematic diagram that capsule is just being positioned in Figure 160 longitudinal hole；

Figure 162 is performed according to the end of the surgery suturing appliance including tissue thickness compensation part of at least one embodiment The perspective view of device；

Figure 163 is the perspective view of the compensating part main body of Figure 166 tissue thickness compensation part；

Figure 164 is the perspective view for the multiple transverse holes being defined in Figure 163 compensating part main body；

Figure 165 is to show the schematic diagram that capsule is just being positioned in Figure 164 transverse holes；

Figure 166 is performed according to the end of the surgery suturing appliance including tissue thickness compensation part of at least one embodiment The perspective view of device；

Figure 167 is the perspective view for the vertical mould that can manufacture tissue thickness compensation part；

Figure 168 is the perspective view for the capsule being just positioned in Figure 167 mould；

Figure 169 is the perspective view of the capsule for the Figure 168 being positioned in Figure 167 mould；

Figure 170 is the mould lid placed and the compensating part material of main part being just positioned in mould for being close to Figure 167 Perspective view；

Figure 171 is the perspective view of Figure 167 mould, shows that Figure 170 lid has been removed；

Figure 172 shows to include the nail of tissue thickness compensation part and tissue thickness compensation part pad according at least one embodiment Storehouse；

Figure 173 is the partial bottom perspective view of Figure 172 tissue thickness compensation part pad；

Figure 174 is the fragmentary top perspective view of Figure 172 tissue thickness compensation part pad；

Figure 175 is the part sectioned view of the Figure 172 just fired by firing member nail bin, thereon there is not nail bin shown in it Position tissue thickness compensation part；

Figure 176 is Figure 172 of the cutting element cutting just engaged by the firing member with Figure 175 tissue thickness compensation part The top view of pad, nail bin shown in it does not have position tissue thickness compensation part thereon；

Figure 177 is Figure 172 of the cutting element cutting just engaged by the firing member with Figure 175 tissue thickness compensation part The top view of pad, tissue thickness compensation part is located in nail bin thereon shown in it；

Figure 178 is to include the circular nail bin according at least one alternative embodiment of circular tissue thickness compensation part pad Plan；

Figure 179 shows to include the mould of multiple cavities, and the multiple cavity can be formed on multiple cartridge bodies simultaneously Tissue thickness compensation part；

Figure 180 shows to be positioned at the cartridge body in Figure 179 cavity and be just placed on above cartridge body one Individual or multiple sheet materials；

Figure 181 shows to be fixed on the sheet material of Figure 180 of appropriate location in Figure 179 mould；

Figure 182 shows to be wound on the elongate tubular structure around multiple post support members in Figure 179 mould；

Figure 183 shows to be fixed on the sheet material of Figure 180 of appropriate location above Figure 179 cartridge body；

Figure 184 shows the pipe component of Figure 182 of appropriate location above the sheet material in Figure 180；

Figure 185 shows that compensating part material of main part is just poured into Figure 179 mould；

Figure 186 shows to be positioned at the cutting die head above Figure 179 mould；

Figure 187 shows to move the cutting die head of the sheet material with the compensating part material of main part of cutting drawing 185 and Figure 180 down；

Figure 188 shows the cutting die head that the mould away from Figure 179 is moved upward；

Figure 189 is the tissue thickness prepared by the manufacturing process described in Figure 179-188 according at least one embodiment Spend the section end view of compensating part；

Figure 190 is the top view of the nail bin including tissue thickness compensation part according at least one embodiment；

Figure 191 is the perspective view of Figure 190 nail bin；

Figure 192 is the diagram of the manufacture of the tissue thickness compensation part for the nail bin for showing Figure 190；

Figure 193 is the diagram of the roller according at least one embodiment, the roll-in flat bar expects pipe and formed tissue thickness benefit Repay part；

Figure 194 is the diagram of the roller of the formation tissue thickness compensation part according at least one alternative embodiment；

Figure 195 is the fragmentary, perspective view for the nail bin for including tissue thickness compensation part prepared by the technique as shown in Figure 194；

Figure 196 is just from the cross-section front view of the nail of Figure 195 cartridge deployment；And

Figure 197 is just from the section end view of the nail of Figure 195 cartridge deployment.

Through multiple views, corresponding reference symbol indicates corresponding part.Example as shown herein shows in one form Certain embodiments of the present invention, and the scope that such example should not be construed as in any way limiting the present invention are gone out.

Embodiment

Present applicant also possesses following U.S. Patent application, and these patent applications are each complete by reference It is incorporated herein entirely：

Entitled " the SURGICAL INSTRUMENTS WITH RECONFIGURABLE SHAFT SEGMENTS " U.S. Patent application serial number 12/894,311 (attorney END6734USNP/100058)；

Entitled " SURGICAL STAPLE CARTRIDGES SUPPORTING NON-LINEARLY ARRANGED STAPLES AND SURGICAL STAPLING INSTRUMENTS WITH COMMON STAPLE-FORMING POCKETS” U.S. Patent Application Serial Number 12/894,340 (attorney END6735USNP/100059)；

Entitled " JAW CLOSURE ARRANGEMENTS FOR SURGICAL INSTRUMENTS " United States Patent (USP) Shen Please sequence number 12/894,327 (attorney END6736USNP/100060)；

Entitled " SURGICAL CUTTING AND FASTENING INSTRUMENTS WITH SEPARATE AND DISTINCT FASTENER DEPLOYMENT AND TISSUE CUTTING SYSTEMS " U.S. Patent Application Serial Number 12/894,351 (attorney END6839USNP/100524)；

Entitled " IMPLANTABLE FASTENER CARTRIDGE HAVING A NON-UNIFORM ARRANGEMENT " U.S. Patent Application Serial Number 12/894,338 (attorney END6840USNP/100525)；

Entitled " IMPLANTABLE FASTENER CARTRIDGE COMPRISING A SUPPORT RETAINER " U.S. Patent Application Serial Number 12/894,369 (attorney END6841USNP/100526)；

Entitled " IMPLANTABLE FASTENER CARTRIDGE COMPRISING MULTIPLE LAYERS " U.S. State's patent application serial number 12/894,312 (attorney END6842USNP/100527)；

It is entitled that " the SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE " U.S. is special Sharp patent application serial numbers 12/894,377 (attorney END6843USNP/100528)；

Entitled " SURGICAL STAPLING INSTRUMENT WITH COMPACT ARTICULATION CONTROL ARRANGEMENT " U.S. Patent Application Serial Number 12/894,339 (attorney END6847USNP/100532)；

Entitled " SURGICAL STAPLING INSTRUMENT WITH A VARIABLE STAPLE FORMING SYSTEM " U.S. Patent Application Serial Number 12/894,360 (attorney END6848USNP/100533)；

Entitled " SURGICAL STAPLING INSTRUMENT WITH INTERCHANGEABLE STAPLE CARTRIDGE the ARRANGEMENTS " (attorney of U.S. Patent Application Serial Number 12/894,322 END6849USNP/100534)；

Entitled " SURGICAL STAPLE CARTRIDGES WITH DETACHABLE SUPPORT STRUCTURES AND SURGICAL STAPLING INSTRUMENTS WITH SYSTEMS FOR PREVENTING ACTUATION MOTIONS WHEN A CARTRIDGE IS NOT the PRESENT " (agent of U.S. Patent Application Serial Number 12/894,350 File number END6855USNP/100540)；

Entitled " IMPLANTABLE FASTENER CARTRIDGE COMPRISING BIOABSORBABLE LAYERS " U.S. Patent Application Serial Number 12/894,383 (attorney END6856USNP/100541)；

Entitled " COMPRESSIBLE FASTENER CARTRIDGE " U.S. Patent Application Serial Number 12/894,389 (attorney END6857USNP/100542)；

Entitled " FASTENERS SUPPORTED BY A FASTENER CARTRIDGE SUPPORT " United States Patent (USP) Patent application serial numbers 12/894,345 (attorney END6858USNP/100543)；

Entitled " COLLAPSIBLE FASTENER CARTRIDGE " U.S. Patent Application Serial Number 12/894,306 (attorney END6859USNP/100544)；

Entitled " FASTENER SYSTEM COMPRISING A PLURALITY OF CONNECTED RETENTION MATRIX ELEMENTS " (the attorney END6860USNP/ of U.S. Patent Application Serial Number 12/894,318 100546)；

Entitled " FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND AN ALIGNMENT MATRIX " U.S. Patent Application Serial Number 12/894,330 (attorney END6861USNP/100547)；

Entitled " FASTENER SYSTEM COMPRISING A RETENTION MATRIX " U.S. Patent application sequence Row number 12/894,361 (attorney END6862USNP/100548)；

Entitled " FASTENING INSTRUMENT FOR DEPLOYING A FASTENER SYSTEM COMPRISING A RETENTION the MATRIX " (attorney of U.S. Patent Application Serial Number 12/894,367 END6863USNP/100549)；

Entitled " FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND A COVER " U.S. State's patent application serial number 12/894,388 (attorney END6864USNP/100550)；

Entitled " FASTENER SYSTEM COMPRISING A PLURALITY OF FASTENER CARTRIDGES " U.S. Patent Application Serial Number 12/894,376 (attorney END6865USNP/100551)；

Entitled " SURGICAL STAPLER ANVIL COMPRISING A PLURALITY OF FORMING POCKETS " U.S. Patent Application Serial Number 13/097,865 (attorney END6735USCIP1/100059CIP1)；

Entitled " TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER " United States Patent (USP) Patent application serial numbers 13/097,936 (attorney END6736USCIP1/100060CIP1)；

Entitled " STAPLE CARTRIDGE COMPRISING A VARIABLE THICKNESS COMPRESSIBLE PORTION " U.S. Patent Application Serial Number 13/097,954 (attorney END6840USCIP1/100525CIP1)；

Entitled " STAPLE CARTRIDGE COMPRISING STAPLES POSITIONED WITHIN A COMPRESSIBLE PORTION the THEREOF " (attorney of U.S. Patent Application Serial Number 13/097,856 END6841USCIP1/100526CIP1)；

It is entitled " TISSUE THICKNESS COMPENSATOR COMPRISING DETACHABLE PORTIONS's " U.S. Patent Application Serial Number 13/097,928 (attorney END6842USCIP1/100527CIP1)；

Entitled " TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER COMPRISING AN ADJUSTABLE ANVIL " (the attorney END6843USCIP1/ of U.S. Patent Application Serial Number 13/097,891 100528CIP1)；

Entitled " STAPLE CARTRIDGE COMPRISING AN ADJUSTABLE DISTAL PORTION " U.S. State's patent application serial number 13/097,948 (attorney END6847USCIP1/100532CIP1)；

Entitled " COMPRESSIBLE STAPLE CARTRIDGE ASSEMBLY " U.S. Patent Application Serial Number 13/ 097,907 (attorney END6848USCIP1/100533CIP1)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING PORTIONS HAVING DIFFERENT the PROPERTIES " (attorney of U.S. Patent Application Serial Number 13/097,861 END6849USCIP1/100534CIP1)；

Entitled " STAPLE CARTRIDGE LOADING ASSEMBLY " U.S. Patent Application Serial Number 13/097, 869 (attorney END6855USCIP1/100540CIP1)；

It is entitled " COMPRESSIBLE STAPLE CARTRIDGE COMPRISING ALIGNMENT MEMBERS's " U.S. Patent Application Serial Number 13/097,917 (attorney END6856USCIP1/100541CIP1)；

Entitled " STAPLE CARTRIDGE COMPRISING A RELEASABLE PORTION " United States Patent (USP) Shen Please sequence number 13/097,873 (attorney END6857USCIP1/100542CIP1)；

Entitled " STAPLE CARTRIDGE COMPRISING COMPRESSIBLE DISTORTION RESISTANT COMPONENTS " (the attorney END6858USCIP1/ of U.S. Patent Application Serial Number 13/097,938 100543CIP1)；

It is entitled " STAPLE CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR's " U.S. Patent Application Serial Number 13/097,924 (attorney END6859USCIP1/100544CIP1)；

Entitled " SURGICAL STAPLER WITH FLOATING ANVIL " U.S. Patent Application Serial Number 13/ 242,029 (attorney END6841USCIP2/100526CIP2)；

Entitled " CURVED END EFFECTOR FOR A STAPLING INSTRUMENT " U.S. Patent application sequence Row number 13/242,066 (attorney END6841USCIP3/100526CIP3)；

Entitled " STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK " U.S. Patent Application Serial Number 13/242,086 (attorney END7020USNP/110374)；

Entitled " the STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK ARRANGEMENT " U.S. Patent application serial number 13/241,912 (attorney END7019USNP/110375)；

Entitled " SURGICAL STAPLER WITH STATIONARY STAPLE DRIVERS " U.S. Patent application Sequence number 13/241,922 (attorney END7013USNP/110377)；

Entitled " SURGICAL INSTRUMENT WITH TRIGGER ASSEMBLY FOR GENERATING MULTIPLE ACTUATION the MOTIONS " (attorney of U.S. Patent Application Serial Number 13/241,637 END6888USNP3/110378)；And

Entitled " SURGICAL INSTRUMENT WITH SELECTIVELY ARTICULATABLE END EFFECTOR " U.S. Patent Application Serial Number 13/241,629 (attorney END6888USNP2/110379).

Present applicant also possesses following U.S. Patent application, and these patent applications are carried on the same day with the application Hand over, and each is each integrally incorporated herein by reference：

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF LAYERS " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6864USCIP2/100550CIP2)；

Entitled " EXPANDABLE TISSUE THICKNESS COMPENSATOR " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6843USCIP2/100528CIP2).

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING A RESERVOIR " United States Patent (USP) Patent application serial numbers _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6843USCIP3/100528CIP3)；

It is entitled " RETAINER ASSEMBLY INCLUDING A TISSUE THICKNESS COMPENSATOR's " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6843USCIP4/100528CIP4)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING AT LEAST ONE MEDICAMENT " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6843USCIP5/ 100528CIP5)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING CONTROLLED RELEASE AND EXPANSION " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6843USCIP6/ 100528CIP6)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING FIBERS TO PRODUCE A RESILIENT LOAD " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6843USCIP7/ 100528CIP7)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING STRUCTURE TO PRODUCE A RESILIENT LOAD " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6843USCIP8/ 100528CIP8)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING RESILIENT MEMBERS " U.S. State's patent application serial number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6843USCIP9/100528CIP9)；

Entitled " METHODS FOR FORMING TISSUE THICKNESS COMPENSATOR ARRANGEMENTS FOR SURGICAL STAPLERS " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6843USCIP10/100528CP10)；

Entitled " TISSUE THICKNESS COMPENSATORS " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6843USCIP11/100528CP11)；

Entitled " LAYERED TISSUE THICKNESS COMPENSATOR " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6843USCIP12/100528CP12)；

Entitled " TISSUE THICKNESS COMPENSATORS FOR CIRCULAR SURGICAL STAPLERS " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6843USCIP13/100528CP13)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING CAPSULES DEFINING A LOW PRESSURE ENVIRONMENT " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END7100USNP/110601)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISED OF A PLURALITY OF MATERIALS " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END7101USNP/ 110602)；

It is entitled " MOVABLE MEMBER FOR USE WITH A TISSUE THICKNESS COMPENSATOR's " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END7107USNP/110603)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF MEDICAMENTS " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END7102USNP/ 110604)；

It is entitled " TISSUE THICKNESS COMPENSATOR AND METHOD FOR MAKING THE SAME's " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END7103USNP/110605)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING CHANNELS " United States Patent (USP) Shen Please sequence number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END7104USNP/110606)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING TISSUE INGROWTH FEATURES " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END7105USNP/110607)； And

Entitled " DEVICES AND METHODS FOR ATTACHING TISSUE THICKNESS COMPENSATING MATERIALS TO SURGICAL STAPLING INSTRUMENTS " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END7106USNP/110608).

Some exemplary embodiments will now be described, to understand the knot of apparatus and method as disclosed herein on the whole Structure, function, manufacture and purposes.One or more examples of these embodiments are shown in the drawings.The ordinary skill people of this area Member is it should be appreciated that it is unrestricted exemplary embodiment to specifically describe herein and be illustrated in the apparatus and method in accompanying drawing. The feature that one exemplary embodiment is illustrated or described, can be combined with the feature of other embodiments.It is such Modifications and variations are included within the scope of the invention.

Can using it is disclosed herein or it is claimed be used for manufacture, formed or in other words article of manufacture or Any of method of product manufacturing, formed or in other words produce considered product or whole or the portion of product Point, and in the case where being manufactured using such method, being formed or in other words produce the part of considered product or product, Can article of manufacture or product in any way remainder, including by using disclosed herein and claimed Be used for manufacture, formed or in other words any of other method of article of manufacture or product, and can be with any side The various pieces that formula combination is so produced.Similarly, disclosed herein or claimed any product or product Can individualism, combined with so disclosed any other product compatible or product in the presence of or its overall portion of conduct Divide and exist.Therefore, can by with reference to shown in a kind of product, product or method or described special characteristic, structure or characteristic all or Unrestrictedly combined with the feature or characteristic of other one or more biocompatible articles, product or method part.Such modification and change Type is included within the scope of the invention.

With reference to certain figures or otherwise, in the specific embodiment or some systems of invention disclosed herein In the case that product, product or method may include some structures, characteristic or feature, reader should be appreciated that this represents those structures, spy Property or feature structure can be embodied in considered product, product or method with any compatible combination.Specifically, it is multiple optional Such disclosure of structure, characteristic or feature should be understood in addition disclose in combination all that structure, characteristic or Except feature, but situation as the structure disclosed in alternative form each other, characteristic or feature.In this class formation, characteristic or spy Levy as in the case of disclosed in alternative form each other, this should be understood to disclose those alternative forms as mutual Replace.

Terms used herein " nearside " and " distal side " be the clinician relative to the handle portions of manipulation of surgical apparatus and Speech.Term " nearside " refers to the part near clinician, and term " distal side " refers to the part away from clinician.Should also Work as understanding, for the sake of succinct and be clear, such as " vertical ", " level ", "up" and "down" etc can be used with reference to accompanying drawing herein Spatial terminology.However, surgical instruments is used in many directions and position, and these terms and it is nonrestrictive and/or Absolute.

There is provided various exemplary means and method to perform laparoscopic type and minimally invasive surgical procedures.However, reader Will be apparent from, various method and apparatus disclosed herein can be used for many surgical procedures and application (including with opening The application that formula surgical procedures are combined) in.With continued reference to present embodiment, reader will be further understood that, this paper institutes Disclosed various apparatuses can in any way in insertion body, such as by natural cavity, by the otch that is formed in tissue or Puncturing hole etc..The working portion or end effector portion of apparatus can be plugged directly into patient's body or can be by logical with work The entrance device in road and insert, the end effector and slender axles of surgical instruments can be promoted by the service aisle.

Accompanying drawing is gone to, wherein in multiple views, similar numeral represents similar component, and Fig. 1, which is shown, to be put into practice The surgical instruments 10 of some unique benefits.Surgery suturing appliance 10 is designed to manipulate and/or activated and is operationally attached To the various forms and the end effector 12 of size of surgery suturing appliance 10.In Fig. 1-Fig. 1 E, such as end effector 12 Including elongated passageway 14, the lower jaw 13 of elongated passageway formation end effector 12.Elongated passageway 14 can support " implantable " nail bin 30 and also movably support as end effector 12 upper jaw 15 anvil block 20.

Elongated passageway 14 can be formed with interval such as can be made as 300＆400 series 17-4＆17-7 stainless steels, titanium Side wall 16.Anvil block 20 as 300＆400 series 17-4＆17-7 stainless steels, titanium under it can process, and can be shaped with nail Surface, the nail shaped lower face is generally indicated as 22 and is formed with multiple nail shapes pits 23.Referring to Figure 1B -1E. In addition, anvil block 20 have from anvil block 20 to nearside it is raised be divided into two-part slide assemblies 24.Anvil block pin 26 is from slide assemblies 24 each horizontal lateral process, to receive in respective slots or opening 18 in the side wall 16 of elongated passageway 14, so as to be conducive to By anvil block pin 26 movably or be attached pivotally to the respective slots or opening 18.

Various forms of implanted nail bins can be used together with surgical instruments disclosed herein.It will discuss in more detail below State specific nail bin configuration and construction.However, in figure ia, showing implanted nail bin 30.Nail bin 30 has main part 31, The main part is by compressible hemostatic material (such as oxidized regenerated cellulose (" ORC ") or bioabsorbable foam) structure Into wherein being supported by the unfashioned peg 32 of multirow.For anti-non-magnetic shim it is impacted and prevent hemostatic material introduce and position It is activated during process, whole storehouse can be coated with or be enclosed with biodegradable film 38, such as with trade markSell Six cyclic ketones films or polyglycerol sebacate (PGS) film (are gathered in oneself by PGA (polyglycolic acid is sold with trade mark Vicryl), PCL Ester), PLA or PLLA (PLA), PHA (polyhydroxyalkanoatefrom), PGCL (Poliglecaprone 25 is sold with trade mark Monocryl) Or other biodegradable films of PGA, PCL, PLA, PDS compound formation, ability is permeable only in rupture for the film. Being sized to of the main body 31 of nail bin 30 is removedly supported in elongated passageway 14 as depicted so that when anvil block 20 It is driven to when being contacted with the formation of nail bin 30, each of which nail 32 is aligned with corresponding nail shapes pit 23.

In use, once end effector 12 is positioned adjacent to target tissue, end effector 12 is just manipulated to target group Knit capture or be clamped between the upper surface 36 of nail bin 30 and the nail profiled surface 22 of anvil block 20.Nail 32 in the following way into Shape：Anvil block 20 is set to be moved in the path for being arranged essentially parallel to elongated passageway 14, so as to follow closely profiled surface 22 and more specifically make Nail shapes pit 23 therein substantially simultaneously contacts the top surface 36 of nail bin 30.As anvil block 20 is continuously moved in nail bin 30, The leg 34 of nail 32 contacts corresponding nail shapes pit 23 in anvil block 20, nail shapes pit 23 be used to bend nail leg 34 so that Nail 32 is configured to " B shapes ".The further motion of anvil block 20 towards elongated passageway 14 will compress further nail 32 and schedule to last its shaping The final forming height " FF " hoped.

Above-mentioned nail forming process is generally described in Figure 1B -1E.For example, Figure 1B shows end effector 12, wherein target group " T " is knitted to be located between anvil block 20 and the top surface 36 of implantable nail bin 30.Fig. 1 C show the initial clamped position of anvil block 20, wherein anvil Seat 20 is closed up to target tissue " T ", and target tissue " T " is clamped between anvil block 20 and the top surface 36 of nail bin 30.Fig. 1 D Initial nail shaping is shown, wherein anvil block 20 is had started to compress nail bin 30 so that the leg 34 of nail 32 is begun through in anvil block 20 Nail shapes pit 23 and shape.Fig. 1 E show the nail 32 in final shaped state through target tissue " T ", for clarity Remove anvil block 20.Once nail 32 shapes and is fastened to target tissue " T ", surgeon just makes anvil block 20 move to open position, with Warehouse 31 and nail 32 is set to remain attached to target tissue when withdrawing from end effector 12 from patient.When two jaws 13,15 During common clamping, end effector 12 makes all nails shape simultaneously.Remaining " by conquassation " material of main part 31 is used as styptic And staple line reinforcing agent (the other film compositions 38 of PGA, PDS or any of above) (ORC).Further, since nail 32 during shaping not Warehouse 31 must be left, therefore nail 32 is changed into lopsided possibility during shaping and is minimized.As used herein, term " implantation Formula " refers to that in addition to nail the warehouse material of support nail also would be held in patient's body and finally can be absorbed by patient body.This Class implanted nail bin is different from previous nail bin structure, and the previous nail bin construction is still intactly fixed after it is fired Position is in end effector.

In various specific implementations, end effector 12 can be connected to the Slender axles assembly from the projection of shank assembly 100 40.End effector 12 (in closure) and Slender axles assembly 40 can have similar shape of cross section, and its size is set Determine into and trocar tube or service aisle are passed through with another access instruments formal operations.As used herein, term is " operationally Through " refer to that passage can be inserted or may pass through at least a portion of end effector and Slender axles assembly by passage or tube opening Or tube opening, and can be if necessary in being manipulated in passage or tube opening to it to complete surgery stitching operation.When in closure During position, the jaw 13 and 15 of end effector 12 can provide the shape of cross section of substantial circular in favor of it for end effector Through circular path/opening.It is contemplated, however, that the end effector and Slender axles assembly of the present invention have other cross sections Shape, entering path and opening with non-circular transverse cross-section are passed through so as to other modes.Therefore, the end of closure The overall dimension of the cross section of actuator by end effector by through passage or opening size it is related.Therefore, one End effector is for example referred to alternatively as " 5mm " end effector, and this refers to that it operationally can be at least about through diameter 5mm opening.

Slender axles assembly 40 can have the external diameter of substantially equal with the external diameter of end effector 12 in the close position.Example Such as, 5mm end effectors can be connected to the Slender axles assembly 40 with 5mm cross-sectional diameters.However, specific real with continued reference to this Apply mode, it will be apparent that, the present invention can be effectively combined various sizes of end effector and use.For example, 10mm ends Portion's actuator could attach to the slender axles with 5mm cross-sectional diameters.On the contrary, for wherein providing 10mm or bigger entrance is opened For the application of mouth or passage, Slender axles assembly 40 can have 10mm (or bigger) cross-sectional diameter, but can also activate 5mm Or 10mm end effectors.Therefore, the external diameter that the external diameter of outer shaft 40 can be with the end effector 12 for the closure for being attached to outer shaft 40 It is identical or different.

As illustrated, Slender axles assembly 40 is distally extending substantially along straight line from shank assembly 100, to limit longitudinal direction Axis A-A.For example, Slender axles assembly 40 can be about 9-16 inches (229-406mm) length.However, Slender axles assembly 40 is settable For other length, and there can be joint wherein or can otherwise be conducive to end effector 12 relative to axle or handle The other parts of parts carry out joint motions, and following article will be discussed in more detail.Slender axles assembly 40 includes ridge component 50, should Ridge component extends to end effector 12 from shank assembly 100.The proximal extremity of the elongated passageway 14 of end effector 12 has Keep lugs 17 from a pair of its projection, this pair keep lug be sized to receive in the distal end of ridge component 50 In the corresponding lug opening or support 52 that are provided, so that end effector 12 can removedly couple Slender axles assembly 40.Ridge component 50 can be by being made such as 6061 or 7075 aluminium, stainless steel, titanium.

Shank assembly 100 includes pistol grasping type shell, and the pistol grasping type shell can be made into for assembling purpose Two or more parts.For example, shank assembly 100 as depicted is including by polymer or plastic material molding or in other words Say being made and be designed to the right hand housing member 102 and the left hand housing member (not shown) that are combined together.Can by Wherein mold or the snap in features structure, bolt and the pod that are in other words formed, and/or will be such by adhesive, screw etc. Housing member is attached together.Ridge component 50 has proximal extremity 54, and flange 56 is formed with the proximal extremity.The energy of flange 56 Enough it is rotationally supported within groove 106, the groove is from the fit ribs from housing member 102, each of 104 to inner process 108 form.This structure is conducive to ridge component 50 to be attached to shank assembly 100, while enabling ridge component 50 relative to shank Component 100 rotates along 360 ° of paths around longitudinal axis A-A.

As in Fig. 1 it can further be shown that ridge component 50 is through axle bush 60 and is supported by axle bush 60, the installation Axle bush 60 is pivotally attached to shank assembly 100.Axle bush 60 have proximal flange 62 and distal lip 64, and the nearside is convex Edge and distal lip limit rotated trench 65, and the rotated trench can rotatably connect the leading edge portion 101 of shank assembly 100 It is received in therebetween.This structure enables axle bush 60 to be rotated relative to shank assembly 100 around longitudinal axis A-A.Ridge component 50 By ridge pin 66 non-rotatably pin joint to axle bush 60.In addition, turn knob 70 is attached to axle bush 60.For example, rotation Button 70 has hollow mounting flange portion 72, and being sized to of the hollow mounting flange portion connects a part for axle bush 60 It is received in wherein.Knob 70 can by such as glass or carbon filled nylon, makrolon,Etc. being made, and also by ridge pin 66 are attached to axle bush 60.In addition, being formed in mounting flange portion 72 and can extend to the holding flange 74 of inner process It is formed in the radial groove 68 in axle bush 60.Therefore, surgeon can be by firmly grasping turn knob 70 and making its relative Rotated in shank assembly 100, and ridge component 50 (and being attached to the end effector 12 of ridge component 50) is surrounded longitudinal axis A-A Rotated along 360 ° of paths.

Anvil block 20 is maintained at open position by anvil block spring 21 and/or another biased configuration.By being substantially marked as 109 trigger system, anvil block 20 can optionally move to various closures or clamped position and firing position from open position. Trigger system 109 includes " firing member " 110, and it includes hollow firing tube 110.Hollow firing tube 110 can be in ridge component 50 It is axially movable, therefore forms the outside of Slender axles assembly 40.Firing tube 110 can be by polymer or other suitable material systems Into, and with the proximal extremity for the percussion yoke 114 for being attached to trigger system 109.For example, percussion yoke 114 is moldable to arrive firing tube 110 proximal extremity.However, can also use other securing members constructions.

As can be seen in Figure 1, percussion yoke 114 can be pivotally supported in support lining ring 120, the support lining ring energy It is enough to be axially moved in shank assembly 100.Support lining ring 120 has a pair of fins extended laterally, and the size of this pair of fin is set Determine into and be slidably received in the fin slit being formed in left hand housing member and right hand housing member.Therefore, support lining Circle 120 can slide axially in shank housing 100, while enabling percussion yoke 114 and firing tube 110 relative to support lining ring 120 rotate around longitudinal axis A-A.According to the present invention, firing tube 110 is provided with longitudinal slit, so that ridge pin 66 can Extended to through longitudinal slit in ridge component 50, while being conducive to firing tube 110 axially to be advanced in ridge component 50.

Trigger system 109 also includes firing trigger 130, and the firing trigger is used to control firing tube 110 in ridge component Axial movement on 50.Referring to Fig. 1.Such a moved to along distal direction of firing tube 110 carries out percussion phase interaction with anvil block 20 Axial movement is referred to herein as " percussion motion ".As can be seen in Figure 1, firing trigger 130 passes through pivot pin 132 movably or are pivotally coupled to shank assembly 100.Firing trigger 130 is biased using torsionspring 135 remote The pistol grip portion 107 of shank assembly 100 and reach " opening " or original position not activated.As can be seen in Figure 1, hit Sending out trigger 130 has top 134, and the top is movingly attached (pin joint) and arrives percussion chain link 136, and the percussion chain link is movable Support lining ring 120 is arrived in ground attachment (pin joint).Therefore, firing trigger 130 is from original position 1) towards the hand of adjacent shank component 100 The motion of the firing trigger 130 of the end position of pistol grip portion 107 will make percussion yoke 114 and firing tube 110 along distal side Move in direction " DD ".The motion of pistol grip portion 107 of the firing trigger 130 away from shank assembly 100 is (in torsionspring Under 135 biasing) percussion yoke 114 and firing tube 110 will be caused to be moved in ridge component 50 along proximal direction " PD ".

The present invention can be used together from different sizes with the implanted nail bin of configuration.For example, being connected when combining the first percussion Son 140 is in use, surgical instruments 10 can be held with the 5mm ends for the about 20mm length (or with other length) for supporting implanted nail bin 30 Row device 12 is used together.This end effector size can be particularly well-suited in for example realizing dissection and the blood vessel of opposite fine Processing.However, following article institute is described in more detail, for example, it can also be held in the mouth by the way that the first percussion adapter 140 is replaced by into the second percussion Connect son and surgical instruments 10 is used in combination with the end effector and nail bin of other sizes.As other alternative form, carefully Long axis component 40 can be attached to the end effector of only a kind of form or size.

A kind of method that end effector 12 is removedly connected to ridge component 50 will be explained now.By that elongated will lead to Start connection process in the lug support 52 in holding lug 17 insertion ridge component 50 on road 14.Then, surgeon will Firing trigger 130 is promoted towards the pistol grip 107 of casing assembly 100, by the percussion adapter of firing tube 110 and first 140 are advanced distally into above the proximal end portions 47 of elongated passageway 14, so that lug 17 is maintained at into its respective support In 52.The position of the first percussion adapter 140 on lug 17 is referred to here as " coupled position ".The present invention can also have End effector locked component, for locking firing trigger 130 just after being attached to ridge component 50 in end effector 12 Position.

More particularly, one embodiment of end effector locked component 160 includes retaining pin 162, the retaining pin quilt It is movably supported in the top 134 of firing trigger 130.As described above, firing tube 110 must be distad pushed into first To coupled position, wherein the holding lug 17 of end effector 12 is maintained in ridge component 50 by the first percussion adapter 140 In lug support 52.Surgeon is held in the mouth percussion by pulling firing trigger 130 towards pistol grip 107 from original position Connect son 140 and be advanced distally into the coupled position.When firing trigger 130 is activated first, retaining pin 162 is distad transported Dynamic, until the first percussion adapter 140 is advanced to coupled position by firing tube 110, now retaining pin 162, which is biased to, is formed at In latch well 164 in housing member.Optionally, when retaining pin 162 enters in latch well 164, pin 162 can send audible " clicker " sound or other sound, and for surgeon provide end effector 12 be " locked " in ridge component 50 touch Feel and indicate.As long as in addition, retaining pin 162 intentionally is not biased out into latch well 164, surgeon just will not unintentionally activate and hit Trigger 130 is sent out to start to make the nail 32 in end effector 12 to shape.Similarly, if surgeon's release is in connection position The firing trigger 130 put, then retaining pin 162 firing trigger 130 can be made to be maintained at the position, to prevent firing trigger 130 are back to original position and therefore discharge end effector 12 from ridge component 50.

The present invention may also include trigger system locking press button 137, and the trigger system locking press button is with can be pivotably It is attached to shank assembly 100.In one form, trigger system locking press button 137 has the door bolt formed in its distal end Lock 138, the breech lock is oriented to the engagement percussion yoke 114 of breech lock 138 when firing release button and being in the first position latching.Such as exist It can be seen that in Fig. 1, late spring 139 is used to trigger system locking press button 137 being biased to the first position latching.In various situations Under, breech lock 138 is used at following point engage percussion yoke 114：At this point, the position pair of the percussion yoke 114 in ridge component 50 Ying Yu wherein the first percussion adapters 140 will be advanced to the point in the clamping slideway 28 on anvil block 20 towards distal side.It should be appreciated that As the first percussion adapter 140 is vertically to propulsion in clamping slideway 28, anvil block 20 will be moved along path so that nail shaping table Face 22 is arranged essentially parallel to the top surface 36 of nail bin 30.

After end effector 12 is connected to ridge component 50, opened by depressing trigger system locking press button 137 first Begin nail forming process, so that percussion yoke 114 can further be moved in ridge component 50 towards distal side and most anvil block 20 compresses at last Into nail bin 30.After pressure trigger system locking press button 137, surgeon, which continues to activate towards pistol grip 107, to be fired Trigger 130, so that being driven into the first nail lining ring 140 on corresponding nail shaping slideway 29, to force anvil block 20 and nail bin The shaping contact of nail 32 in 30.Trigger system locking press button 137 is prevented before surgeon is ready to start nail forming process Inadvertently shape nail 32.In such embodiment, surgeon must be before firing trigger 130 can be further actuated Trigger system locking press button 137 is depressed to start to follow closely forming process.

Surgical instruments 10 can be used only as tissue apposition device as needed.However, the present invention may also comprise tissue cutting System, the tissue diced system is substantially marked as 170.In at least one form, tissue diced system 170 includes cutter component 172, can be by activating cutter traveling trigger 200 by the cutter component optionally from the nearside end of adjacent side terminal part actuator 12 The unactuated position at end is advanced to actuated position.Cutter component 172 is movably supported in ridge component 50, and is attached to knife bar 180 or in other words from the projection of knife bar 180.Cutter component 172 can be by such as hardness with more than 38HRC (RHC) 420 or 440 stainless steels be made, and can have and be formed at tissue cutting edge 176 in its distal end 174, and can The slit in anvil block 20 and the slit being centrally located in nail bin 30 33 are slidably extended through, end is clamped in cut through and holds Tissue in row device 12.Knife bar 180 extends through ridge component 50 and with the proximal extremity that handing-over is driven with Cutter conveyer Part, the Cutter conveyer is operably attached to cutter traveling trigger 200.Cutter traveling trigger 200 is attached to pivot pin 132 so that it can be pivoted in the case where that need not activate firing trigger 130 or in other words activated.According to this hair Bright, first cutter tooth wheel 192 is also attached to pivot pin 132 so that the actuating of cutter traveling trigger 200 also makes first cutter tooth wheel 192 Pivot.Percussion return spring 202 is attached between first cutter tooth wheel 192 and shank housing 100, by knife actuating trigger 200 It is biased to original position or unactuated position.

Cutter conveyer also includes the second cutter tooth wheel 194, and second cutter tooth wheel is pivotally supported on second gear axle And engaged with first cutter tooth wheel 192.Second cutter tooth wheel 194 is engaged with the 3rd gear shaft 196 being supported on the 3rd gear shaft.The Four cutter tooth wheels 198 are also supported on the 3rd gear shaft 195.4th cutter tooth wheel 198 can be driven the nearside for being bonded on knife bar 180 A series of gear teeths or ring on end.Therefore, this structure enable 4th cutter tooth wheel 198 along distal direction " DD " or Proximal direction " PD " axially trigger shaft 180, while making trigger shaft 180 relative to 4th cutter tooth wheel 198 around longitudinal axis A-A Rotation.Therefore, surgeon can pull knife actuating trigger 200 by the pistol grip 107 towards shank assembly 100 and make to hit Hair bar 180 is axially promoted and most all morning distal side promotes cutter component 172.

Present invention additionally comprises cutter locking system 210, the cutter locking system prevents the propulsion of cutter component 172, unless percussion is touched Hair device 130 has been pulled to complete firing position.Therefore, this structure will prevent the activation of knife propulsion system 170, unless nail is Fired or formed in tissue first.As can be seen in Figure 1, the various specific implementations of cutter locking system 210 are locked including knife Fixed pole 211, the cutter securing rod 211 is pivotally supported in the pistol grip portion 107 of shank assembly 100.Cutter securing rod 211 With activated end 212, when firing trigger 130 is in complete firing position, activated end 212 can be by firing trigger 130 Engagement.In addition, cutter securing rod 211 has on the other end thereof keeps suspension hook 214, the holding suspension hook can be engaged in suspension hook mode Latch bar 216 on first cutting gear 192.Cutter securing rod 211 is biased to by " locking " position using Lock spring 218 Put.In " locking " position, suspension hook 214 is kept to keep engaging with latch bar 216, so as to prevent knife actuating trigger 200 Actuating, unless firing trigger 130 is in complete firing position.

After nail is " fired " (shaping) into target tissue, surgeon can depress percussion trigger release button 167, So that firing trigger 130 can be back to original position under the bias of torsionspring 135, so that anvil block 20 can Open position is biased downwards into the bias of spring 21.When in open position, surgeon can withdraw from end effector 12 and leave implantable nail bin 30 and nail 32.What end effector passed through passage, service aisle etc. and was inserted into wherein should In, surgeon will make anvil block 20 be back to closing position by activating firing trigger 130, so that end effector 12 It can be withdrawn by by the passage or service aisle.However, if surgeon wants to cut target tissue after percussion nail, Then surgeon activates cutter traveling trigger 200 in the above described manner, and end effector is reached through target tissue with trigger shaft 172 End.Then, the releasable cutter traveling trigger 200 of surgeon, so that percussion return spring 202 can make percussion transmission dress Put and knife bar 172 is back to starting (does not activate) position.Once knife bar 172 is back to original position, surgeon just can open End effector jaw 13,15, implanted storehouse 30 is released in patient's body and end execution is then withdrawn from out of patient body Device 12.Therefore, such surgical instruments is conducive to small using what can be inserted into by relatively small service aisle and passage Implanted nail bin, while providing following selection for surgeon：The percussion nail or if necessary in hitting in the case where not cutting tissue Tissue is also cut after hair nail.

The various unique and new embodiments of the present invention use compressible nail bin, and the compressible nail bin support is in Substantially fixed position is for by the nail of anvil block shaping contact.Anvil block is driven into unshaped nail, wherein for example being reached Nail shaping degree depend on anvil block be driven to follow closely in how far.Such construct allows a surgeon to regulation and applied to nail Shaping or percussion pressure amount, so as to change the final forming height of nail.In other embodiments of the invention, surgical stapling Construction can use nail driving element, and the nail driving element can lift nail towards anvil block.These are by further detail below Description.

Optionally, the amount with reference to the firing action for above, being applied to movable anvil block depends on the actuating of firing trigger Degree.If for example, surgeon goes for the nail of only part shaping, only needed towards pistol grip 107 partially inwardly Depress firing trigger.Want to obtain more nail shapings, surgeon only needs further to compress firing trigger so that anvil block Contacted by further driving with being formed with nail.As used herein, term " shaping contact " refers to nail profiled surface or followed closely into Shape pit has contacted the end of nail leg and has had started to that leg is shaped or bent to shaping position.The degree of nail shaping refers to nail leg The degree that is folded and the forming height for finally referring to nail referred to above.Those skilled in the art will be further Understand, because when applying percussion motion to anvil block 20, anvil block 20 is moved with the relation substantially parallel with nail bin, institute Substantially simultaneously shaped and with substantially the same forming height with following closely.

Fig. 2 and Fig. 3 show alternative end effector 12 ", and the difference of knife bar 172 ' can be accommodated except following Outside, end effector 12 " is similar to above-mentioned end effector 12 '.Knife bar 172 ' is connected to knife bar 180 or prominent from knife bar 180 Rise, and in addition operated in the way of above in connection with described in knife bar 172.However, in this embodiment, knife bar 172 ' long enoughs do not use single distal blade to traverse the whole length of end effector 12 ", therefore in end effector 12 " Component.Cross member 173 ' and lower cross member 175 ' are formed with knife bar 172 '.Upper cross member 173 ' is oriented to can Corresponding elongated slot 250 in anvil block 20 " is slidably traversed, and lower cross member 175 ' is oriented to traverse end effector Elongated slot 252 in 12 " elongated passageway 14 ".It is also equipped with departing from slit (not shown) in anvil block 20 " so that work as knife bar 172 ' when being driven to the end position in end effector 12 ", and upper cross member 173 ' falls through corresponding slit, with Make anvil block 20 " that open position can be moved to, so as to depart from the tissue that sutures and cut.Anvil block 20 " can in addition with Above-mentioned anvil block 20 is identical, and elongated passageway 14 " can be in addition identical with above-mentioned elongated passageway 14.

In these embodiments, anvil block 20 " is biased to fully open position by spring or other Unclosing structure (not shown) (Fig. 2).Anvil block 20 " is advanced by the axial direction that percussion adapter 150 is carried out in the above described manner and clamped in open position with complete Moved between position.Once percussion adapter 150 is advanced into fully clamped position (Fig. 3), surgeon just can be then with above-mentioned Mode promotes knife bar 172 " towards distal side.If surgeon wants end effector carrying out manipulating tissue as grasp device, Percussion adapter can proximally be moved, to allow anvil block 20 " to be moved away from elongated passageway 14 ", as shown in phantom in figure 4. In this embodiment, when knife bar 172 " is moved towards distal side, upper cross member 173 ' and lower cross member 175 ' are while pull anvil Seat 20 " and elongated passageway 14 ", desired nail is realized to be reached when knife bar 172 " is promoted through end effector 12 " towards distal side Shaping.Referring to Fig. 5.Therefore, in this embodiment, nail shaping is that occur simultaneously with tissue cutting, but nail in itself can be in knife bar 172 " sequentially shape when being driven towards distal side.

The various surgery nail bins of the present invention and unique and new feature of surgical instruments enable the nail in the nail bin It is arranged to one or more line linearly or nonlinearly.A plurality of this staple line can be set on each side of elongated slot, it is described elongated Slit is centrally arranged in nail bin, for accommodating the tissue cutting element through the elongated slot.In a kind of arrangement side In formula, such as nail into a line can be substantially parallel to the nail in adjacent staple line but deviate with it.Replaced as other For form, one or more staple line can be essentially nonlinear.In other words, the base portion of at least one nail in staple line can be along base Extend in sheet with the crosscutting axis of the base portion of other nails in same staple line.For example, the staple line on every side of elongated slot can With sawtooth appearance.

According to the present invention, nail bin may include warehouse and the multiple nails being stored in warehouse.In use, nail bin can be introduced In operative site and it is located on the side of handled tissue.In addition, can be by nail shaping anvil positioning in the relative of tissue On side.Anvil block can be carried by the first jaw and nail bin can be carried by the second jaw, wherein the first jaw and/or the second jaw can Towards the motion of another jaw.Once nail bin and anvil block are positioned relative to tissue, then nail can be projected from cartridge body so that nail can Pierce through tissue and contact stud shaping anvil block.Once disposing nail from cartridge body, then cartridge body can be removed from operative site.Nail It is implantable at least a portion of storehouse or nail bin to have nail.For example, following article is more fully described, nail bin may include warehouse, when When anvil block moves to closing position from open position, the warehouse can be compressed by anvil block, conquassation and/or collapse.Compressed when warehouse, Conquassation and/or when collapsing, the nail in warehouse can be deformed by anvil block.Alternately, for supporting the pincers of nail bin Mouth can move to closing position towards anvil block.Two kinds of situations it is any in, when nail is positioned at least partially in warehouse, nail It is deformable.In some cases, nail can not be shot up from nail bin, and in other cases, the part one that nail can be with warehouse Rise and be shot up from nail bin.

Referring now to Fig. 6 A-6D, compressible nail bin (such as nail bin 1000) for example may include compressible implanted warehouse 1010, and the multiple nails 1020 being also located in compressible warehouse 1010, but Fig. 6 A-6D only show a nail 1020.Figure 6A shows the nail bin 1000 supported by nail bin supporting member or staple cartridge channel 1030, and wherein nail bin 1000 is shown at uncompressed Situation.Under such uncompressed situation, anvil block 1040 is accessible or does not contact tissue T.In use, anvil block 1040 can be from opening Position moves into contact tissue T, as shown in Figure 6B, and tissue T is positioned against warehouse 1010.Even if anvil block 1040 will can be organized The tissue contacting surface 1019 of T against staple cartridge body 1010 is positioned, but referring again to Fig. 6 B, staple cartridge body 1010 now can be by pole Few (if any) compression stress or pressure, and follow closely and 1020 be positively retained under unshaped or non-percussion situation.Such as Fig. 6 A and Shown in Fig. 6 B, staple cartridge body 1010 may include one or more layers, and follow closely 1020 nail leg 1021 and may pass through these layers and prolong upwards Stretch.Warehouse 1010 may include first layer 1011, the second layer 1012, third layer 1013 and the 4th layer 1014, the wherein second layer 1012 It can be positioned between first layer 1011 and third layer 1013, wherein third layer 1013 can be positioned on the second layer 1012 and the 4th layer Between 1014.For example, the base portion 1022 of nail 1020 can be positioned in the cavity 1015 in the 4th layer 1014, and nail leg 1021 can Upwardly extended from base portion 1022 and through the 4th layer 1014, third layer 1013 and the second layer 1012.Optionally, it is each deformable Leg 1021 may include top, such as sharp top 1023, such as when nail bin 1000 is in uncompressed situation, the sharp top End can be positioned in the second layer 1012.For example, top 1023 can be not extend to and/or through first layer 1011, wherein working as nail bin 1000 be in uncompressed situation when, top 1023 convex can not wear tissue contacting surface 1019.When nail bin is in uncompressed situation, Sharp top 1023 can be positioned in third layer 1013 and/or any other suitable layer.Alternatively, nail bin Warehouse can have any suitable number of layers, such as less than four layers or more than four layers.

Optionally, it is more fully described as following, first layer 1011 can be by buttress material and/or plastic material (example Such as polydioxanone (PDS) and/or polyglycolic acid (PGA)) constitute, and the second layer 1012 can be by bioabsorbable bubble Foam material and/or compressible hemostatic material (such as oxidized regenerated cellulose (ORC)) are constituted.Optionally, first layer 1011, Nail 1020 can be maintained in staple cartridge body 1010 by two layer 1012, third layer 1013 and the 4th layer one or more of 1014, and And in addition nail 1020 can be made to keep aligned with each other.Third layer 1013 can be by buttress material or quite incompressible or non-resilient Material is constituted, and the nail leg 1021 for following closely 1020 can be held in place by by the material relative to each other.In addition, positioned at third layer The second layer 1012 in 1013 opposite sides and the 4th layer 1014 can stablize or reduce the motion of nail 1020, even if the second layer 1012 and the 4th layer 1014 may include compressible foam or elastomeric material.The screw top end 1023 of nail leg 1021 can be at least in part In embedded first layer 1011.For example, first layer 1011 and third layer 1013 can be collaboratively and firmly by nail legs 1021 It is held in place by.First layer 1011 and third layer 1013 can be respectively by such as bioabsorbable material (such as with trade name Polyglycolic acid (PGA), PLA (PLA or PLLA), polydioxanone (PDS), the poly (hydroxy alkanoate) of Vicryl sales Ester (PHA), with trade name Monocryl sell Poliglecaprone 25 (PGCL), polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL and/or PCL compound) thin slice constitute, and the second layer 1012 and the 4th layer 1014 can be respectively by extremely Few a kind of hemostatic material or styptic are constituted.

Although first layer 1011 can be compressible, but the second layer 1012 can more be pressed substantially than first layer 1011 Contracting.For example, the compressibility of the second layer 1012 can for about twice, about three times, about four times, about five times of first layer 1011 and/or About ten times.In other words, for given power, the compression degree of the second layer 1012 can for about twice of first layer 1011, about three times, About four times, about five times, and/or about ten times.The compressibility of the second layer 1012 for example can first layer 1011 approximately twice as with Between about ten times.The second layer 1012 may include the amount for being defined in multiple air gaps therein, the wherein air gap in the second layer 1012 And/or size can be controlled to provide the expectation compressibility of the second layer 1012.It is similar as above, although third layer 1013 can be It is compressible, but the 4th layer 1014 can substantially have more compressibility than third layer 1013.For example, the 4th layer 1014 can Compressibility can be about twice, about three times, about four times, about five times, and/or about ten times of third layer 1013.In other words, for given Power, the 4th layer 1014 of compression degree can for about twice, about three times, about four times, about five times of third layer 1013, and/or about Ten times.4th layer 1014 of compressibility can be between third layer 1013 be approximately twice as about ten times.4th layer 1014 can Including being defined in multiple air gaps therein, wherein the amount and/or size of air gap in the 4th layer 1014 can be controlled to provide 4th layer 1014 of expectation compressibility.In various scenarios, can (that is, layer be directed to the power of given size and pressed by compression ratio The distance of contracting) come express warehouse or warehouse layer compressibility.For example, compared with the layer compared with little compressible, with high pressure The layer of shrinkage will compress bigger distance for applying to the compression stress of the given size of this layer.For so, the second layer 1012 There is higher compression ratio than first layer 1011；Similarly, there is higher compression than third layer 1013 for the 4th layer 1014 Rate.The second layer 1012 and the 4th layer 1014 can be made up of and can have identical compression ratio identical material.The second layer 1012 It can be made up of with the 4th layer 1014 the material with different compression ratios.Similarly, first layer 1011 and third layer 1013 may include Identical material simultaneously can have identical compression ratio.First layer 1011 and third layer 1013 can be by the materials with different compression ratios Constitute.

As anvil block 1040 is moved towards its closing position, anvil block 1040 can contact tissue T and to tissue T and nail bin 1000 Apply compression stress, as shown in Figure 6 C.In this case, anvil block 1040 can push down on warehouse 1010 towards nail bin supporting member 1030 Top surface or tissue contacting surface 1019.Nail bin supporting member 1030 may include storehouse stayed surface 1031, and it can be in nail bin 1000 Nail bin 1000 is supported when being compressed between storehouse stayed surface 1031 and the tissue contacting surface 1041 of anvil block 1040.Due to anvil block 1040 pressure applied, warehouse 1010 can be compressed and the accessible nail 1020 of anvil block 1040.More particularly, warehouse 1010 Compression and the first layer for moving downward the puncture of top 1023 warehouse 1010 that can make nail leg 1021 of tissue contacting surface 1019 1011st, pierce through tissue T and enter in the forming pit 1042 in anvil block 1040.As warehouse 1010 is further by anvil block 1040 Compression, top 1023 can contact the wall for limiting forming pit 1042, and therefore leg 1021 can be deformed inward or crimp, for example As shown in Figure 6 C.As nail leg 1021 deforms, equally as shown in Figure 6 C, the base portion 1022 of nail 1020 can contact nail bin support Part 1030 is supported by nail bin supporting member 1030.Optionally, as described in greater detail below, nail bin supporting member 1030 may include many Individual supporting construction, such as nail support trenches, slit or groove 1032, such as the multiple supporting construction can be deformed in nail 1020 When support nail 1020 or at least nail 1020 base portion 1022.Equally as shown in Figure 6 C, the cavity 1015 in the 4th layer 1014 can be by Collapsed in the compression stress for being applied to staple cartridge body 1010.In addition to cavity 1015, cartridge body 1010 may also include one or many It can be located in individual space (such as space 1016), such as one or more of spaces or no-fix has the part of nail, institute State one or more spaces and can allow for warehouse 1010 and collapse.Cavity 1015 and/or space 1016 can collapse so that limit chamber The wall of body and/or wall deflects down and contacts storehouse stayed surface 1031 and/or contact warehouse 1010 is positioned at cavity and/or sky Layer below gap.

In relatively Fig. 6 B and Fig. 6 C, it is clear that the second layer 1012 and the 4th layer 1014 are substantially applied by anvil block 1040 Plus compression pressure compression.It may also be noted that first layer 1011 and third layer 1013 are also compressed.Closed when anvil block 1040 moves to it When closing position, anvil block 1040 can continue further pressure by pushing down on tissue contacting surface 1019 towards nail bin supporting member 1030 Contracting warehouse 1010.As warehouse 1010 is further compressed, anvil block 1040 can make nail 1020 be deformed to it to be fully formed shape, such as Shown in Fig. 6 D.Referring to Fig. 6 D, the leg 1021 of each nail 1020 can downwards be deformed towards the base portion 1022 of each nail 1020, so as to by group T, first layer 1011, the second layer 1012, third layer 1013 and the 4th layer 1014 at least a portion is knitted to capture in deformable leg Between 1021 and base portion 1022.In relatively Fig. 6 C and Fig. 6 D, more obviously, the second layer 1012 and the 4th layer 1014 substantially by The compression pressure that anvil block 1040 is applied further compresses.In relatively Fig. 6 C and Fig. 6 D it may also be noted that arriving, the He of first layer 1011 Third layer 1013 has also been further compressed.After nail 1020 is fully shaped completely or at least, anvil block 1040 can be remote Tissue T and be lifted, and nail bin supporting member 1030 can away from and/or depart from nail bin 1000 move.As shown in Figure 6 D and make For above-mentioned result, warehouse 1010 is implantable nail 1020.In various scenarios, the warehouse 1010 being implanted can be supported along staple line Tissue.In some cases, the styptic and/or any other suitable medicine included in the warehouse 1010 of implantation can be with Time passage to handle tissue.Styptic as described above can reduce the tissue bleeding of suture and/or cutting, while bonding agent Or tissue adhesive can over time elapse and provide intensity for tissue.The warehouse 1010 being implanted into can be by such as ORC (oxidation regenerations Cellulose), extracellular protein (such as collagen), with trade name Vicryl sell polyglycolic acid (PGA), PLA (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoatefrom (PHA), the Poliglecaprone sold with trade name Monocryl The material of 25 (PGCL), polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL and/or PCL compound is constituted. In some situations, warehouse 1010 may include the antibiosis and/or anti-biotic material that can reduce the possibility of surgical site infection, for example Collargol and/or triclosan.

The layer of warehouse 1010 can be connected with each other.For example, using at least one adhesive (such as fibrin and/or Protein hydrogel) second layer 1012 is adhered into first layer 1011, third layer 1013 is adhered into the second layer 1012, and by Adhere to third layer 1013 for four layer 1014.Although not shown, the layer of warehouse 1010 can be connected by interlocking machine feature structure Together.For example, first layer 1011 and the second layer 1012 can each include corresponding interlocking features structure, such as tenon groove structure And/or dovetail structure.Similarly, the second layer 1012 and third layer 1013 can each include corresponding interlocking features structure, Third layer 1013 and the 4th layer 1014 can each include corresponding interlocking features structure simultaneously.Although not shown, nail bin 1000 may include for example one or more rivets, and one or more rivets can extend across the one or more of warehouse 1010 Layer.For example, each rivet may include the first end that adjacent first layer 1011 positions or head and it is neighbouring 4th layer 1014 and Second head of positioning, the 4th layer can be assembled into the second end of rivet or be formed by the second end of rivet.For example, by In the compressible character of warehouse 1010, rivet compressible warehouse 1010 so that the head of rivet can relative to warehouse 1010 group Knit contact surface 1019 and/or lower surface 1018 is recessed.For example, rivet can be by bioabsorbable material (such as with commodity Polyglycolic acid (PGA), PLA (PLA or PLLA), polydioxanone (PDS), poly- hydroxyalkanoate that name Vicryl is sold Acid esters (PHA), with trade name Monocryl sell Poliglecaprone 25 (PGCL), polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL and/or PCL compound) constitute.In addition to nail 1020 accommodated in by warehouse 1010, warehouse 1010 Layer can not be connected to each other.For example, being frictionally engaged between nail leg 1021 and warehouse 1010 can for example protect the layer of warehouse 1010 Hold together, and once nail shaping, then the layer, which can be trapped in, follows closely in 1020.At least a portion of nail leg 1021 may include The roughened surface or rough coatings for following closely the frictional force between 1020 and warehouse 1010 can be increased.

As described above, surgical instruments may include the first jaw and the second jaw, the first jaw includes nail bin supporting member 1030, Second jaw includes anvil block 1040.Optionally, described in greater detail below, nail bin 1000 may include that one or more holdings are special Structure is levied, one or more holding feature structures can engage nail bin supporting member 1030 and therefore that nail bin 1000 is releasable Ground remains to nail bin supporting member 1030.For example, at least one adhesive (such as, fibrin and/or albumen water-setting can be passed through Glue) nail bin 1000 is adhered into nail bin supporting member 1030.In use, at least one situation, especially in laparoscopic type And/or in endoscopic procedure, such as the second jaw is moveable to the closing position relative with the first jaw so that the first jaw It can be inserted into the second jaw by trochar in operative site.For example, trochar can limit about 5mm hole or intubation, the One jaw and the second jaw can be inserted into by it.Second jaw is moveable in an open position between closing position Partial closed position, the partial closed position can allow the first jaw and the second jaw to be inserted into through trochar, without making Nail 1020 accommodated in staple cartridge body 1010 is deformed.For example, when the second jaw is in the centre position that its part is closed, anvil block 1040 can not apply compression stress to staple cartridge body 1010, and when the second jaw is in the centre position that its part is closed, anvil block 1040 compressible nail bin bodies 1010.Although the compressible nail bin main body 1010 when anvil block 1040 is in this centre position, but Anvil block 1040 can incompletely compress cartridge body 1010, so as to the contact stud 1020 of anvil block 1040 and/or cause nail 1020 by anvil Seat 1040 is deformed.Once the first jaw and the second jaw are inserted into operative site by trochar, then the second jaw can quilt It is again turned on, and anvil block 1040 and nail bin 1000 can be positioned relative to target tissue as described above.

Referring now to Fig. 7 A-7D, the end effector of surgical stapling device may include that be positioned at anvil block 1140 supports with nail bin Implanted nail bin 1100 between part 1130.Similar as above, anvil block 1140 may include tissue contacting surface 1141, nail bin 1100 It may include tissue contacting surface 1119, and nail bin supporting member 1130 may include that the support surface of nail bin 1100 can be supported 1131.Referring to Fig. 7 A, can on the premise of deforming nail bin 1100 using anvil block 1140 by tissue T against nail bin 1100 group Contact surface 1119 is knitted to position, and when anvil block 1140 is in this position, tissue contacting surface 1141 can be positioned so that and follow closely The distance 1101a of storehouse stayed surface 1131, and tissue contacting surface 1119 can be positioned so that and nail bin support surface 1131 Distance 1102a.Then, referring now to Fig. 7 B, as anvil block 1140 is moved towards nail bin supporting member 1130, anvil block 1140 can be to The top surface of lower promotion nail bin 1100 or the first layer 1111 and the second layer of tissue contacting surface 1119 and nail bin support member 1110 1112.As layer 1111 and layer 1112 are compressed, referring again to Fig. 7 B, the second layer 1112 can be by conquassation, and follows closely 1120 leg 1121 pierceable first layers 1111 are simultaneously entered in tissue T.For example, nail 1120 can be positioned at least partially in the second layer 1112 Nail cavity or space 1115 in, and when the second layer 1112 is compressed, nail cavity 1115 is collapsible and therefore allows the second layer 1112 collapse around nail 1120.The second layer 1112 may include cover 1116, and the cover may extend away above nail cavity 1115 simultaneously Surround or at least partially around nail cavity 1115.Fig. 7 B show the cover 1116 for being pressed downward and bursting in nail cavity 1115.The It may include one or more weakening parts for two layer 1112, it can be conducive to collapsing for the second layer 1112.Optionally, such weakenings Divide the controllable cut collapsed, perforation and/or the thin cross section that may include for example be conducive to warehouse 1110.First layer 1111 It may include one or more weakening parts that nail leg 1121 can be conducive to penetrate first layer 1111.Optionally, such weakenings Divide cut, perforation and/or the thin cross section that may include for example to be aligned or at least substantially be aligned with nail leg 1121.

Referring again to Fig. 7 A, when anvil block 1140 is in part closure, non-firing position, anvil block 1140 can be positioned so that with The distance 1101a of storehouse stayed surface 1131 so that define gap therebetween.This gap can be by with nail bin height 1102a's Nail bin 1100 and tissue T filling.As anvil block 1140 is moved downward to compress nail bin 1100, referring again to Fig. 7 B, tissue contact The distance between surface 1141 and storehouse stayed surface 1131 can be limited by being shorter than apart from 1101a apart from 1101b.In various situations In, between the tissue contacting surface 1141 and storehouse stayed surface 1131 of anvil block 1140 can be big by the gap limited apart from 1101b In original undeformed nail bin height 1102a.Referring now to Fig. 7 C, as anvil block 1140 is transported closer to storehouse stayed surface 1131 Dynamic, the second layer 1112 can continue to collapse and the distance between nail leg 1121 and forming pit 1142 can reduce.Similarly, tissue connects Touching the distance between surface 1141 and storehouse stayed surface 1131 can be reduced to apart from 1101c, the distance can greater than, equal to or be less than Original not deformed storehouse height 1102a.Referring now to Fig. 7 D, anvil block 1140 is moveable to final firing position, wherein following closely 1120 are fully formed or are at least shaped to Desired Height.In this position, the tissue contacting surface 1141 of anvil block 1140 Can be with the distance 1101d of storehouse stayed surface 1131, wherein original not deformed storehouse height 1102a can be shorter than apart from 1101d.Together As illustrated in fig. 7d, nail cavity 1115 can completely or at least substantially be collapsed sample, and nail 1120 can completely or at least substantially be collapsed The second layer 1112 of contracting is surround.In various scenarios, anvil block 1140 can be moved then away from nail bin 1100.Once anvil block 1140 from Nail bin 1100 departs from, then warehouse 1110 for example, at least can partly spread over various positions again (that is, between adjacent nail 1120 Position) in.The warehouse 1110 of conquassation may not extend resiliently again.The nail 1120 of shaping and it is positioned in addition adjacent Nail 1120 between warehouse 1110 can apply pressure or compression stress to tissue T, this can provide various treatment benefits.

As described above, referring again to Fig. 7 A, each nail 1120 may include the nail leg 1121 extended from.Although following closely 1120 quilts It is schematically shown as including two nail legs 1121, but can also be used may include a nail leg or alternately includes following closely more than two The various nails of leg (such as three nail legs or four nail legs).As shown in Figure 7 A, each nail leg 1121 can be embedded into warehouse 1110 The second layer 1112 in so that nail 1120 is fixed in the second layer 1112.Nail 1120 can be inserted into the nail cavity in warehouse 1110 In 1115 so that the top 1123 of nail leg 1121 is advanced into cavity 1115 base portion 1122.Chamber is inserted on top 1123 After body 1115, top 1123 can be pressed against in cover 1116 and cut the second layer 1112.Nail 1120 can be rested upon to the Enough depths in two layer 1112 so that nail 1120 is not moved relative to the second layer 1112 or do not moved at least substantially.Nail 1120 can be rested upon enough depths into the second layer 1112 so that base portion 1122 is positioned or is embedded in nail cavity 1115.Make For another selection, base portion 1122 can not be positioned or be embedded in the second layer 1112.Referring again to Fig. 7 A, base portion 1122 can be in storehouse The lower section of lower surface 1118 of body 1110 extends.Base portion 1122 can be bearing in storehouse stayed surface 1130 or directly abut storehouse support Surface 1130 is positioned.Storehouse stayed surface 1130 may include from its extension and/or be limited to supporting construction therein, for example, nail 1120 base portion 1122 can be positioned in such as one or more of nail bin supporting member 1130 support trenches, slit or groove 1132 In or supported by one or more support trenches, slit or groove 1132, described in greater detail below.

Referring now to Fig. 8 and Fig. 9, nail bin (such as nail bin 1200) for example may include compressible implanted warehouse 1210, The warehouse includes outer layer 1211 and internal layer 1212.Similar as above, nail bin 1200 may include the multiple nails being located in warehouse 1210 1220.Optionally, each nail 1220 may each comprise base portion 1222 and one or more nail legs 1221 from its extension.For example, Nail leg 1221 can be inserted into internal layer 1212 and be rested upon to for example making the base portion 1222 of nail 1220 abut and/or neighbouring internal layer 1212 Lower surface 1218 position depth.In figs. 8 and 9, internal layer 1212 does not include the part that can receive nail 1220 Nail cavity, and alternatively, internal layer 1212 may include such nail cavity.Further described above, internal layer 1212 Can be by can allow for compressible material (such as bioabsorbable foam that warehouse 1210 is collapsed when applying compressive load to it And/or oxidized regenerated cellulose (ORC)) constitute.Internal layer 1212 can be by for example comprising PLA (PLA) and/or polyglycolic acid (PGA) freeze dried foam is constituted.ORC can it is commercially available with trade name Surgicel and may include loose Woven fabric (as Surgical sponge is the same), loose fiber (as cotton balls) and/or foam.Internal layer 1212 can be by wherein including and/or applying above The material for being covered with medicine (fibrin ferment and/or fibrin that are such as freeze-dried) is constituted, and the medicine for example can be by patient's body Interior fluid water activation and/or activation.For example, the fibrin ferment and/or fibrin of freeze-drying are positively retained at for example In Vicryl (PGA) matrix.However, in some cases, such as when in the operative site that nail bin 1200 is inserted into patient's body When, activable medicine can be activated inadvertently.Referring again to Fig. 8 and Fig. 9, outer layer 1211 can be impermeable by water or at least The substantially impermeable material of water is constituted so that liquid does not contact or do not contact internal layer 1212 at least substantially, until warehouse 1210 are compressed and nail leg has been penetrated after outer layer 1211 and/or after outer layer 1211 cut in some manner.Example Such as, outer layer 1211 can be by buttress material and/or plastic material (such as polydioxanone (PDS) and/or polyglycolic acid (PGA)) constitute.Outer layer 1211 may include the wrappage of wrappage around internal layer 1212 and nail 1220.More particularly, nail 1220 can be inserted Enter in internal layer 1212 and outer layer 1211 and be wrapped and be subsequently sealed around the sub-component for including internal layer 1212 and nail 1220.

As described herein, when anvil block moves to closing position, the nail of nail bin can be fully formed by anvil block.As another Selection, referring now to Figure 10-Figure 13, such as nail of the nail bin of nail bin 4100 for example can be by when anvil block moves to closing position Anvil block, and additionally by make nail towards closure anvil block move Staple drivers system and deform.Nail bin 4100 may include can The warehouse 4110 of compression, compressible warehouse 4110 for example by foamed material and can be at least partially situated at compressible warehouse Multiple nails 4120 in 4110 are constituted.Staple drivers system may include driver clamper 4160, be positioned at driver clamper Staple drivers 4162 can be maintained at driving by multiple staple drivers 4162 and cartridge tray 4180 in 4160, the cartridge tray In device clamper 4160.For example, staple drivers 4162 can be positioned on one or more of driver clamper 4160 slit In 4163, the side wall of wherein slit 4163 can help to boot up staple drivers 4162 towards anvil block.Nail 4120 can be by staple drivers 4162 are supported in slit 4163, wherein when following closely 4120 and staple drivers 4162 are in its non-firing position, nail 4120 can be complete It is positioned at entirely in slit 4163.Alternatively, when following closely 4120 and staple drivers 4162 are in its non-firing position, nail The openend 4161 that 4120 at least a portion may pass through slit 4163 is upwardly extended.For example, referring now primarily to Figure 11, nail 4120 base portion can be positioned in driver clamper 4160, and the top of nail 4120 can be embedded in compressible warehouse 4110 It is interior.About 1/3rd height of nail 4120 can be positioned in driver clamper 4160, and follow closely about three points of 4120 Two height can be positioned in warehouse 4110.Referring to Figure 10 A, such as nail bin 4100 may also include around warehouse 4110 and driving The water impervious wrappage or film 4111 of device clamper 4160.

In use, for example, nail bin 4100 can be positioned in staple cartridge channel, and anvil block can be moved to towards nail bin 4100 and closed Close in position.When anvil block moves to its closing position, anvil block can contact and compress compressible warehouse 4110.When anvil block is in During its closing position, anvil block can not contact stud 4120.When anvil block moves to its closing position, the leg of the accessible nail 4120 of anvil block And at least in part deform nail 4120.In any case in both cases, nail bin 4100 may also include one or many Individual sliding part 4170, one or more of sliding parts can be in the nail bin 4100 along being longitudinally propelling so that sliding part 4170 can be with Afterwards jointing nail driver 4162 and make staple drivers 4162 and nail 4120 towards anvil block move.Sliding part 4170 can be in cartridge tray 4180 Slided between staple drivers 4162.In the case where the closure of anvil block starts the forming process of nail 4120,4120 courts are followed closely Motion can complete forming process and nail 4120 is deformed into its height or at least desired height for being fully formed anvil block upwards. The closure of anvil block do not make nail 4120 deform in the case of, nail 4120 moved upwards towards anvil block can start and complete forming process and Nail 4120 is set to be deformed into its height or at least desired height for being fully formed.Sliding part 4170 can be from the nearside end of nail bin 4100 End is advanced to the distal end of nail bin 4100 so that the nail 4120 in the distal end for being positioned at nail bin 4100 is fully formed it Before, the nail 4120 being positioned in the proximal extremity of nail bin 4100 is fully formed.Referring to Figure 12, sliding part 4170 can each include extremely Few one angled or inclined surface 4711, it can slide below staple drivers 4162 and be lifted as shown in figure 13 and be followed closely Driver 4162.

Further described above, nail 4120 can be formed, so as to by least a portion of tissue T and nail bin 4100 Compressible warehouse 4110 at least a portion capture wherein.After the shaping of nail 4120, the anvil block and nail of surgical stapling device Warehouse channel 4130 can be moved away from the nail bin 4100 being implanted into.In various scenarios, storehouse dish 4180 can jointing nail in a position-stable manner Warehouse channel 4130, wherein as a result, when staple cartridge channel 4130 is pulled away from the warehouse 4110 being implanted into, storehouse dish 4180 can be from can The warehouse 4110 of compression is dismantled.Referring again to Figure 10, storehouse dish 4180 may include relative side wall 4181, and warehouse 4110 can be removable Except ground is positioned between the relative side wall 4181.For example, compressible warehouse 4110 can be compressed between side wall 4181 so that Warehouse 4110 can be removably retained in therebetween during use, and when storehouse dish 4180 are pulled away from, and warehouse 4110 is from storehouse Disk 4180 releasedly departs from.For example, driver clamper 4160 may be connected to storehouse dish 4180 so that when storehouse dish 4180 are from operation When position is removed, driver holder 4160, driver 4162 and/or sliding part 4170 are positively retained in storehouse dish 4180.Driving During device 4162 can project from driver clamper 4160 and stay in operative site.For example, driver 4162 can be by that biological can inhale Material (polyglycolic acid (PGA), PLA (PLA or PLLA), the poly- dioxa hexamethylene such as sold with trade name Vicryl of receipts Ketone (PDS), polyhydroxyalkanoatefrom (PHA), the Poliglecaprone 25 (PGCL) sold with trade name Monocryl, polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL and/or PCL compound) constitute.Driver 4162 could attach to nail 4120 so that driver 4162 is deployed with nail 4120.For example, each driver 4162 may include for example receive nail 4120 The groove of base portion, wherein the groove can receive base portion with pressure cooperation mode and/or snap fit.

Further described above, driver clamper 4160 and/or sliding part 4170 can be projected from storehouse dish 4180. For example, sliding part 4170 can be slided between storehouse dish 4180 and driver clamper 4160 so that when sliding part 4170 promote with When driving up staple drivers 4162 and nail 4120, sliding part 4170 also can make driver clamper 4160 move upward to storehouse dish Outside 4180.For example, driver clamper 4160 and/or sliding part 4170 can be by bioabsorbable materials (such as with commodity Polyglycolic acid (PGA), PLA (PLA or PLLA), polydioxanone (PDS), poly- hydroxyalkanoate that name Vicryl is sold Acid esters (PHA), with trade name Monocryl sell Poliglecaprone 25 (PGCL), polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL and/or PCL compound) constitute.Sliding part 4170 can be integrally formed and/or be attached to driving rod or cut Component is cut, the driving rod or cutting element promote sliding part 4170 through nail bin 4100.In this case, sliding part 4170 can not be projected from storehouse dish 4180 and can be kept together with surgical stapling device, and sliding part 4170 is not attached to wherein In other situations of driving rod, sliding part 4170 can be stayed in operative site.In any case, to further being retouched above State, the compressibility of warehouse 4110 may be allowed to use thicker nail bin in the end effector of surgical stapling device, because When the anvil block closure of stitching unstrument, warehouse 4110 is compressible or shrinks.Deformed at least in part as being followed closely when anvil block is closed Result, higher nail (such as with about 0.18 " nail of staple height), such as wherein about 0.12 can be used " staple height Can be positioned in compressible stratum 4110, and wherein compressible stratum 4110 may have about 0.14 " uncompressed height.

As described herein, nail bin can include multiple nails wherein.Optionally, such nail can be substantially U-shaped by being deformed into Configuration and the metal wire rod composition with two nail legs.It is contemplated that wherein nail may include that various configuration (is such as engaged with one Play and have two or more wire rods of three or more nail legs) alternative form.For forming the one or more of nail Wire rod may include cross section that is circle or at least substantially justifying.Staple line material may include any other suitable cross section, such as just Square and/or rectangle cross section.Nail can be made up of plastic wire.Nail can be made up of the metal wire rod for being coated with plastics.According to The present invention, in addition to nail or as the replacement of nail, storehouse may include the fastener of any suitable type.For example, this fastener can Including pivotable arm, the arm can be folded when being engaged by anvil block.Two-part fastener can be used.For example, nail bin can Including multiple first fastener portions, and anvil block may include multiple second fastener portions；When anvil block is compressed against nail bin, Second fastener portion is connected to the first fastener portion.As described above, sliding part or driver can be promoted in nail bin to complete The forming process of nail.Sliding part or driver can be promoted in anvil block, to move downwardly to one or more formed parts Engaged with relative nail bin and nail or the fastener being positioned in nail bin.

As described herein, nail bin may include to be stored in four nails row therein.Four nails row can be arranged to two Inner side nail row and two outside nail rows.For example, inner side nail row and outside nail row can be positioned in the cutting element or knife in nail bin On first side of slit；Similarly, inner side nail row and outside nail row can be positioned on the second side of cutting element or cutter slit. Nail bin may not include cutting element slit wherein；However, this nail bin may include specified portions, its can be cut by cutting element with Instead of nail bin slit.Similarly, inner side nail row can be arranged in nail bin so that its with cutting element slit wherein equidistantly or at least Substantially it is equally spaced.Similarly, each outside nail row can be arranged in nail bin so that it is equidistant with cutting element slit wherein Ground is at least substantially equally spaced.According to the present invention, nail bin, which may include to be stored in nail bin, is more or less than four Nail row.Nail bin may include six nail rows.For example, nail bin can include three nail rows on the first side of cutting element slit wherein, and Include three nail rows on the second side of cutting element slit wherein.Nail bin may include odd number nail row.For example, nail bin can be in cutting structure Include two nail rows on first side of part slit, and including three nail rows on the second side of cutting element slit wherein.Following closely row can Including with identical or at least substantially identical unshaped staple height nail.Alternatively, one or more nail rows It may include the nail with the unshaped staple height different from other nails.For example, the nail on the first side of cutting element slit wherein can have There is the first unshaped height, and nail on the second side of cutting element slit wherein there can be the second unshaped height, this is second not Forming height is different from the first height.

Optionally, as described above, nail bin may include warehouse, the warehouse is limited to nail cavity therein including multiple.Warehouse can Including platform and top platform surface, wherein each nail cavity can limit the opening in platform surface.As also described above, nail can be determined Position is in each nail cavity so that nail is stored in warehouse until it is shot up from warehouse.Before being shot up from warehouse, nail can It is accommodated in warehouse so that nail is not projecting to platform surface top.In such situation, when nail is positioned under platform surface Fang Shi, can reduce nail be damaged and/or premature contact destination organization possibility.In various scenarios, nail can not fire position Put and moved between firing position, in non-firing position, it is not from warehouse projection, in firing position, it reveals from warehouse Go out and can contact the anvil block for being positioned in nail bin opposite.Anvil block and/or the forming pit being defined in anvil block can be positioned so that away from Preset distance above platform surface so that when nail is disposed from warehouse, nail is deformed into predetermined forming height.In some situations In, the thickness variable for the tissue being trapped between anvil block and nail bin, therefore, thicker tissue can be trapped in some nails And relatively thin tissue can be trapped in other some nails.In either case, by nail be applied to tissue clamping pressure or Power for example can be different because of nail, or changes between the nail on the nail and the other end of nail row on one end of nail row.In some situations In, it can control the gap between anvil block and nail bin platform so that nail applies a certain minimum clamping pressure in each nail.But In some such situations, the significant changes of the clamping pressure in different nails may possibly still be present.Surgery suturing appliance exists Have disclosed in the United States Patent (USP) 7,380,696 that on June 3rd, 2008 announces, the complete disclosure of the patent is by reference It is incorporated herein.Illustrative multi-stroke handle for surgical stapling and cutting off apparatus is in CO-PENDING and jointly owned title For " SURGICAL STAPLING INSTRUMENT INCORPORATING A MULTISTROKE FIRING POSITION Carried out in INDICATOR AND RETRACTION MECHANISM " U.S. Patent Application Serial Number 10/374,026 more detailed Thin description, the disclosure of the patent application is incorporated by reference in its entirety accordingly.Meeting the other application of the present invention can tie Single firing schedule is closed, such as in CO-PENDING and jointly owned entitled " SURGICAL STAPLING INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS " U.S. Patent Application Serial Numbers 10/441, Described in 632, the disclosure of the patent application is incorporated by reference in its entirety accordingly.

As described herein, nail bin may include following device：The device is used for capturing the group in the nail from cartridge deployment The thickness knitted is compensated.Referring to Figure 14, nail bin (such as nail bin 10000) for example may include that rigid Part I (is such as propped up Point 10010) and compressible Part II (such as tissue thickness compensation part 10020) support part.Referring primarily to Figure 16, supporting part 10010 are divided to may include warehouse, top platform surface 10011 and multiple nail cavities 10012.Wherein, it is similar as above, each nail cavity 10012 can limit the opening in platform surface 10011.Nail 10030 can be for example removably positioned in each nail cavity 10012 In.For example, each nail 10030 may include base portion 10031 and the one or more legs 10032 extended from base portion 10031.In nail 10030 by before deployment, and also as described in more detail below, the base portion 10031 of nail 10030 can be by being positioned at support section 10010 Interior staple drivers support, while, the leg 10032 of nail 10030 can be at least partly accommodated in nail cavity 10012.Nail 10030 can be disposed between non-firing position and firing position so that leg 10032 moves across tissue thickness compensation part 10020, the top surface of tissue thickness compensation part 10020 is penetrated, tissue T is penetrated, and contact is positioned in 10000 pairs of nail bin The anvil block in face.When leg 10032 is against deflection, the leg 10032 of each nail 10030 can capture tissue thickness compensation part A part for 10020 part and the tissue T in each nail 10030, and apply compressive force to tissue.To entering above Row is further described, and the leg 10032 of each nail 10030 can be made to be deformed downwardly toward the base portion 10031 of nail, to form nail retention region 10039, in the nail retention region, tissue T and tissue thickness compensation part 10020 can be captured.In various scenarios, nail retention area Domain 10039 can be limited between the inner surface of strained leg 10032 and the inner surface of base portion 10031.Nail retention region Size may depend on a number of factors, the length of such as leg, the diameter of leg, the width of base portion, and/or such as degree of leg deformation.

In the past, surgeon usually needed the suitable nail for having appropriate staple height for the organizational choice to be sutured.Example Such as, surgeon may be selected high nail and be used together and select low nail to be used together with thin tissue with thick tissue.But In some situations, the tissue being just sewn does not have consistent thickness, and therefore, some nails can not realize desired percussion configuration. For example, Figure 48 is shown for the high nail in thin tissue.Referring now to Figure 49, when tissue thickness compensation part (is such as organized thick Spend compensating part 10020) for example when thin tissue is used together, such as formable larger nail is desired percussion configuration.

Due to the compression ratio of tissue thickness compensation part, tissue thickness compensation part can be to capturing the thickness of the tissue in each nail Degree is compensated.More particularly, referring now to Figure 43 and Figure 44, tissue thickness compensation part (such as tissue thickness compensation part 10020) each nail 10030 can be for example occupied according to the thickness and/or type of the tissue accommodated in nail retention region 10039 The larger and/or less part of nail retention region 10039.For example, being trapped in the feelings in nail 10030 in thicker tissue T Under shape, if relatively thin tissue T is trapped in nail 10030, tissue thickness compensation part 10020 can occupy nail retention region 10039 major part.Correspondingly, the situation in nail 10030 is trapped in compared to relatively thin tissue T, if thicker group Knit T to be trapped in nail 10030, then tissue thickness compensation part 10020 can occupy the smaller portions of nail retention region 10039.This Sample, tissue thickness compensation part can compensate for compared with thin tissue and/or compared with thick tissue, and ensure that compression stress is applied to tissue, regardless of whether No matter or the tissue thickness being at least substantially trapped in nail.In addition to the above, tissue thickness compensation part 10020 can compensate to the different type or the tissue of different compression ratios being trapped in different nails 10030.Referring now to figure 44, tissue thickness compensation part 10020, which can be applied compressive force to, may include the vascular tissue T of blood vessel V, and therefore limit blood stream Less compressible blood vessel V is crossed, but desired compression stress is still applied to the tissue T of surrounding.In various scenarios, to upper Text is described further, and tissue thickness compensation part 10020 can also compensate for strained nail.Referring to Figure 45, various nails 10030 Deformation can cause to be limited to the larger nail retention region 10039 in such nail.Due to the resilience of tissue thickness compensation part 10020 Power, referring now to Figure 46, even if being limited at this nail retention region 10039 become in staple 10030 can be extended, positioning Still enough compression pressures can be applied to tissue T in the tissue thickness compensation part 10020 become in staple 10030. In various situations, the tissue thickness compensation part 10020 in the middle of adjacent nail 10030 can have been become suitable around staple 10030 When the nail 10030 of shaping is biased against tissue T, and therefore compression pressure is applied to for example to surround and/or be trapped in and become Tissue in staple 10030.In various scenarios, tissue thickness compensation part can compensate for different tissue densities, described different Tissue density for example can be produced due to calcification, zone of fiber, and/or the tissue for previously having sutured or having handled.

According to the present invention, tissue space fix or unmodifiable can be limited between support section and anvil block, because No matter why the thickness of this tissue being trapped in nail can make nail be deformed into predetermined height.Used when in such situation During tissue thickness compensation part, tissue thickness compensation part is suitable for the tissue being trapped between anvil block and support section nail bin, and And due to the screen resilience of tissue thickness compensation part, additional compression stress can be applied to tissue by tissue thickness compensation part.Join now See Figure 50-Figure 55, formed nail 10030 is predefined height H.Reference picture 50, tissue thickness compensation part is not used, and And tissue T occupies whole nail retention region 10039.Reference picture 57 a, part for tissue thickness compensation part 10020 has been captured In nail 10030, tissue T is compressed, and occupied at least a portion of nail retention region 10039.Referring now to Figure 52, Thin tissue T has been trapped in nail 10030.In this embodiment, the tissue T compressed has about 2/9H height, and The tissue thickness compensation part 10020 compressed has such as about 7/9H height.Referring now to Figure 53, with interior thickness Tissue T has been trapped in nail 10030.In this embodiment, height of the tissue T compressed with about 4/9H, and by The tissue thickness compensation part 10020 of compression has such as about 5/9H height.Referring now to Figure 54, the group with interior thickness T is knitted to be trapped in nail 10030.In this embodiment, the tissue T compressed has about 2/3H height, and is pressed The tissue thickness compensation part 10020 of contracting has such as about 1/3H height.Referring now to Figure 53, thick tissue T has been trapped in In nail 10030.In this embodiment, the tissue T compressed has about 8/9H height, and the tissue thickness compressed is mended Repaying part 10020 has such as about 1/9H height.In various scenarios, tissue thickness compensation part may include compression height, should Compression height includes：Such as about 10% nail retention height, about 20% nail retention height, the retention of about 30% nail are high Degree, about 40% nail retention height, about 50% nail retention height, about 60% nail retention height, about 70% Nail retention height, about 80% nail retention height, and/or about 90% nail retention height.

Nail 10030 may include any suitable unshaped height.Nail 10030 may include for example between about 2mm and about Unshaped height between 4.8mm.Nail 10030 may include such as about 2.0mm, about 2.5mm, about 3.0mm, about 3.4mm, about 3.5mm, about 3.8mm, about 4.0mm, about 4.1mm, and/or about 4.8mm unshaped height.Nail can The height H of deformation can be determined by the distance between platform surface 10011 and relative anvil block of support section 10010.Platform The distance between tissue contacting surface of surface 10011 and anvil block may be, for example, about 0.097 ".Height H can also be by being limited to anvil The depth of forming pit in seat is determined.Forming pit can for example have the depth measured from tissue contacting surface.Optionally, such as Described in greater detail below, nail bin 10000 may also include staple drivers, and the staple drivers can lift nail 10030 towards anvil block, and Nail is lifted or " excessively driving " arrives the top of platform surface 10011.In this case, the forming height H of nail 10030 can also be by 10030 distances being overdriven are followed closely to determine.For example, nail 10030 can be overdriven such as about .028 ", and it can lead Cause nail 10030 to be shaped as such as about 0.189 " height.Nail 10030 can be shaped as such as about 0.8mm, about 1.0mm, about 1.5mm, about 1.8mm, about 2.0mm, and/or about 2.25mm height.Nail, which can be shaped as, to be for example situated between Height between about 2.25mm and about 3.0mm.Further described above, the height of the nail retention region of nail can Determined by the width and diameter of the forming height followed closely and the wire rod including nail.The height of the nail retention region 10039 of nail 10030 Degree may include that the forming height H of nail subtracts two diameter widths of wire rod.Staple line may include such as about 0.0089 " diameter. Staple line may include the diameter for example between about 0.0069 " and about 0.0119 ".For example, the forming height H of nail 10030 0.189 is may be about ", and staple line diameter may be about 0.0089 ", so as to for example produce about 0.171 " nail retention it is high Degree.

Further described above, tissue thickness compensation part may include height that is unpressed or disposing in advance, and One in multiple compression heights can be deformed into.Tissue thickness compensation part may include such as about 0.125 " uncompressed height Degree.The compensating part of tissue thickness may include to be greater than to be equal to about 0.080 " uncompressed height.Tissue thickness compensation part can Including height that is unpressed or disposing in advance, this is highly more than the non-firing height of nail.Tissue thickness compensation part it is unpressed Or the height disposed in advance is for example high by about 10% than the non-firing height of nail, high by about 20%, high by about 30%, high about 40%th, height about 50%, height about 60%, height about 70%, height about 80%, height about 90%, and/or height about 100%. The non-firing height height such as up to about 100% of the comparable nail of height that is unpressed or disposing in advance of tissue thickness compensation part. The height that is unpressed or disposing in advance of tissue thickness compensation part is high than the non-firing height of nail for example more than 100%.Tissue Thickness compensation part may include the uncompressed height of the non-firing height equal to nail.Tissue thickness compensation part may include to be less than nail not The uncompressed height of firing height.The non-firing height of the comparable nail of height that is unpressed or disposing in advance of tissue thickness compensation part It is for example low by about 10%, low by about 20%, low by about 30%, low by about 40%, low by about 50%, low by about 60%, low about 70%th, low about 80%, and/or low by about 90%.Compressible Part II may include uncompressed height, the uncompressed height Higher than the uncompressed height for the tissue T being just sewn.Tissue thickness compensation part may include uncompressed height, the uncompressed height etc. In the uncompressed height for the tissue T being just sewn.Tissue thickness compensation part may include uncompressed height, and the uncompressed height is less than The uncompressed height for the tissue T being just sewn.

As described above, whether thick tissue or thin tissue are trapped in nail, tissue thickness compensation part can be multiple Compressed in forming nail.For example, the nail deformation in staple line or nail row can be made so that the nail retention region each followed closely includes for example big About 2.0mm height, wherein tissue T and tissue thickness compensation part can be compressed in the height.In some cases, tissue T It may include the compression height of the about 1.75mm in nail retention region, and tissue thickness compensation part may include in nail retention region Interior about 0.25mm compression height, so as to obtain adding up to such as about 2.0mm nail retention region height.In some feelings In shape, tissue T may include the compression height of the about 1.50mm in nail retention region, and tissue thickness compensation part may include The compression height of about 0.50mm in nail retention region, so that the nail retention region for obtaining adding up to such as about 2.0mm is high Degree.In some cases, tissue T may include the compression height of the about 1.25mm in nail retention region, and tissue thickness is mended Repaying part may include the compression height of the about 0.75mm in nail retention region, so as to obtain adding up to such as about 2.0mm's Nail retention region height.In some cases, tissue T may include the compression height of the about 1.0mm in nail retention region, and Tissue thickness compensation part may include the compression height of the about 1.0mm in nail retention region, so as to obtain adding up to for example big About 2.0mm nail retention region height.In some cases, tissue T may include the about 0.75mm's in nail retention region Compression height, and tissue thickness compensation part may include the compression height of the about 1.25mm in nail retention region, so as to obtain Add up to such as about 2.0mm nail retention region height.In some cases, tissue T may include in nail retention region About 1.50mm compression height, and tissue thickness compensation part may include that the compression of the about 0.50mm in nail retention region is high Degree, so as to obtain adding up to such as about 2.0mm nail retention region height.In some cases, tissue T may include to cut in nail The compression height of the about 0.25mm in region is stayed, and tissue thickness compensation part may include in nail retention region about 1.75mm compression height, so as to obtain adding up to such as about 2.0mm nail retention region height.

Further described above, tissue thickness compensation part may include the uncompressed height of the firing height less than nail Degree.Tissue thickness compensation part may include the uncompressed height of the firing height equal to nail.Tissue thickness compensation part may include to be higher than The uncompressed height of the firing height of nail.For example, the uncompressed height of tissue thickness compensation part may include for example following thickness：Should Thickness for forming nail height about 110%, about the 120% of forming nail height, forming nail height about 130%, shaping About the 140% of staple height, about the 150% of forming nail height, about the 160% of forming nail height, forming nail height it is big About 170%, about the 180% of forming nail height, about the 190% of forming nail height, and/or forming nail height be about 200%.Tissue thickness compensation part may include uncompressed height, and this is highly more than twice of the firing height of nail.Tissue thickness Compensating part may include compression height, and this is highly about the 85% to about 150% of such as forming nail height.Optionally, as above Described, tissue thickness compensation part can be compressed between uncompressed thickness and compressed thickness.The pressure of tissue thickness compensation part Contracting thickness may be, for example, about the 10% of its uncompressed thickness, about the 20% of its uncompressed thickness, its uncompressed thickness it is big About 30%, its uncompressed thickness about 40%, about the 50% of its uncompressed thickness, its uncompressed thickness about 60%, About the 70% of its uncompressed thickness, about the 90% of about the 80% of its uncompressed thickness, and/or its uncompressed thickness.Group Knit thickness compensation part uncompressed thickness can it is for example thicker than its compressed thickness approximately twice as, about ten times, about 50 times and/ Or about 100 times.The compressed thickness of tissue thickness compensation part can be between about the 60% to about 99% of its uncompressed thickness. The uncompressed thickness of tissue thickness compensation part is than its compressed thickness thickness at least 50%.The uncompressed thickness of tissue thickness compensation part It is thick at most 100 times than its compressed thickness.Compressible Part II can be to be elastic, or at least partly elasticity, and can Tissue T is biased against the deformation leg of nail.For example, compressible Part II elasticity can expand between tissue T and the base portion of nail Exhibition, to promote tissue T against the leg of nail.It is discussed in detail as discussed further below, tissue thickness compensation part can be positioned in group Knit between T and the nail leg of deformation.In various scenarios, as above-mentioned result, tissue thickness compensation part can occupy nail retention Any gap in region.

Tissue thickness compensation part may include the material being characterized with the one or more in following properties：For example, biofacies Capacitive, bioabsorbable, bioresorbable, biodurable, biodegradable, compressible, fluid are absorbable, swellability, Self-expanding, bioactivity, medicine, pharmaceutical activity, anti-sticking, hemostasis, antibiosis, antimicrobial, antiviral, nutrition, cohesive, can Infiltration, hydrophily and/or hydrophobicity.It may include and anvil block and/or nail according to the surgical instruments of the present invention, including anvil block and nail bin The associated tissue thickness compensation part in storehouse, the nail bin include at least one styptic (such as fibrin and fibrin ferment), Antibiotic (such as fortimicin) and medicine (such as matrix metalloproteinase (MMP)).

Tissue thickness compensation part may include synthesis and/or non-synthetic materials.Tissue thickness compensation part may include polymer group Compound, the polymer composition includes one or more synthetic polymers and/or one or more non-synthetic polymers.Synthesis Polymer may include the absorbable polymer of synthesis and/or the non-absorbable polymer of synthesis.Polymer composition may include example Such as biocompatible foam.Biocompatible foam may include for example porous open celled foam and/or porous closed-cell foam.It is raw Thing biocompatible foam can have uniform pore morphology or can have gradient pore form (that is, in the whole depth of foam in a direction On, orifice size gradually increases and becomes macropore).Polymer composition may include porous support, porous matrix, gel-type vehicle, water Gel-type vehicle, solution matrix, thread matrix, tubulose matrix, composite interstitial substance, membrane matrix, Biostatic polymer and can biology drop One or more and combinations thereof in the polymer of solution.For example, tissue thickness compensation part may include by thread matrix Enhanced foam, or may include the foam with additional hydrogel layer, the additional hydrogel layer extends in the presence of body fluid, Organizationally to further provide for compression.According to the present invention, tissue thickness compensation part can also be by material and/or the second layer or the 3rd Coating on layer is constituted, and the coating extends in the presence of body fluid, organizationally to further provide for compression.Such layer can be water-setting Glue, the hydrogel can be synthesize and/or natural source material, and for example can be biological durable and/or biodegradable. Tissue thickness compensation part may include microgel or nanogel.Hydrogel may include the microgel for carrying out self-carbon water compound and/or Nanogel.The usable fibrous nonwoven material that additional flexibility, rigidity, and/or intensity can be provided or fiber mesh type Element strengthens tissue thickness compensation part.According to the present invention, tissue thickness compensation part can have porous form, the porous form table Reveal gradient-structure, aperture for example on a surface and larger hole on the other surface.Such form for It is even more ideal for tissue growth or hemostasis behavior.In addition, gradient can also be combined with the bio-absorbable section of change.It is short-term to inhale It can be preferred to receive section, and to solve the problems, such as hemostasis, and Long-term absorption section can solve to make tissue more preferably be cured in the case of ne-leakage The problem of conjunction.

The example of non-synthetic materials includes but is not limited to lyophilized polysaccharide, glycoprotein, bovine pericardium, collagen, gelatin, fibrin Albumen, fibrinogen, elastin laminin, proteoglycans, keratin, albumin, hydroxyethyl cellulose, cellulose, oxidized fibre Element, oxidized regenerated cellulose (ORC), hydroxypropyl cellulose, carboxyethyl cellulose, carboxymethyl cellulose, chitin, deacetylated shell Polysaccharide, casein, alginates and combinations thereof.

Synthesize the example including but not limited to poly- (lactic acid) (PLA) of absorbable material, it is PLLA (PLLA), poly- interior Ester (PCL), polyglycolic acid (PGA), PTMC (TMC), polyethylene terephthalate (PET), poly- hydroxyl Phenylalkanoic acid ester (PHA), the copolymer of glycolide and 6-caprolactone (PGCL), the copolymerization of glycolide and trimethylene carbonate Thing, poly- (decanedioic acid glyceride) (PGS), poly- (dioxanone) (PDS), polyester, poly- (ortho esters), polyoxy acid ester, poly- Ether-ether, makrolon, polyesteramide, condensing model, polysaccharide, poly- (ester-acid amide), tyrosine-based polyarylate, polyamine, tyrosine-based are gathered Imido-carbonic ester, tyrosine-based polycarbonate, poly- (D, L- lactide-carbamate), poly- (butyric ester), poly- (B- hydroxyls Base butyrate), poly- (E- caprolactones), polyethylene glycol (PEG), poly- [two (carboxyphenoxy) phosphonitriles], poly- (amino acid), intend poly- (amino acid), absorbable polyurethane, poly- (phosphine piperazine), polyphosphazene, polyoxyalkylene, polyacrylamide, poly hydroxy ethyl acrylate, Polyvinylpyrrolidone, polyvinyl alcohol, poly- (caprolactone), polyacrylic acid, poly- acetic acid esters, polypropylene, aliphatic polyester, glycerine, altogether Poly- (ether-ester), poly- oxalic acid alkylidene diol ester, polyamide, poly- (iminocarbonic ester), poly- oxalic acid alkylidene diol ester and it Combination.Polyester may be selected from polylactide, PGA, trimethylene carbonate, polydioxanone, polycaprolactone, Polybutester and combinations thereof.

The absorbable polymer of synthesis may include for example can with brand name VICRYL (polyglactic 910) from Ethicon, Inc. commercially available 90/10 poly- (glycolide-L- lactides) copolymer, can with brand name DEXON from Commercially available American Cyanamid Co. PGA, can be with brand name PDS from Ethicon, Inc. is commercially available Polydioxanone, can with brand name MAXON from American Cyanamid Co. it is commercially available it is poly- (glycolide- Trimethylene carbonate) statistic copolymer, can with brand name MONOCRYL from Ethicon companies it is commercially available 75/ One or more in 25 poly- (glycolide-s-caprolactone-poliglecaprolactone 25) copolymers.

Synthesis non-absorbable material include but is not limited to polyurethane, polypropylene (PP), polyethylene (PE), makrolon, Polyamide, z such as nylon, polyvinyl chloride (PVC), polymethyl methacrylate (PMMA), polystyrene (PS), polyester, polyethers Ether ketone (PEEK), polytetrafluoroethylene (PTFE) (PTFE), polytrifluorochloroethylene (PTFCE), polyvinyl fluoride (PVF), PEP (FEP), polyacetals, polysulfones, silicon and combinations thereof.The non-absorbable polymer of synthesis may include but be not limited to foam elastic Property body and porous elastomers, such as siloxanes, polyisoprene and rubber.Synthetic polymer may include can be with brand name GORE-TEX soft tissue slices are from W.L.Gore＆Associates, the polytetrafluoroethylene (PTFE) (ePTFE) of commercially available Inc. expansion, And with brand name NASOPORE from copolyether ester polyurethane foam commercially available Polyganics.

Polymer composition may include such as by weight about 50% to about 90% PLLA polymer composition, And by weight about 50% to about 10% PCL polymer composition.Polymer composition may include for example by weight The PLLA of gauge about 70%, and by weight about 30% PCL.Polymer composition may include for example big by weight About 55% to about 85% PGA polymer composition, and by weight 15% to 45% PCL combination of polymers Thing.Polymer composition may include such as by weight about 65% PGA, and by weight about 35% PCL.Polymerization Compositions may include such as by weight about 90% to about 95% PGA polymer composition, and by weight About 5% to about 10% PLA polymer composition.

The absorbable polymer of synthesis may include bioabsorbable, biocompatible elastomers copolymer.Suitably may be used Bio-absorbable, biocompatible elastomers copolymer includes but is not limited to 6-caprolactone and the copolymer of glycolide (preferably has Have from about 30:70 to about 70:30, preferably 35:65 to about 65:35, and more preferably 45:55 to 35:65 6-caprolactone With the mol ratio of glycolide)；6-caprolactone and lactide (including its L- lactide, the blend of D- lactides or lactic acid copolymerization Thing) elastomer copolymer (preferably with from about 35:65 to about 65:35, more preferably 45:55 to 30:70 6-caprolactone with The mol ratio of lactide), the elastomer of dioxanone and lactide (including L- lactides, D- lactides and lactic acid) is total to Polymers (1,4- dioxane -2- ketone) is (preferably with from about 40:60 to about 60:40 rub to dioxanone and lactide You compare)；6-caprolactone and to the elastomer copolymer of dioxanone (preferably with from about 30:70 to about 70:30 ε-oneself Lactone and the mol ratio to dioxanone)；It is (excellent to the elastomer copolymer of dioxanone and trimethylene carbonate Choosing has about 30:70 to about 70:The mol ratio of 30 pairs of dioxanones and trimethylene carbonate)；Trimethylene carbonate Elastomer copolymer with glycolide is (preferably with about 30:70 to about 70:Mole of 30 trimethylene carbonates and glycolide Than)；The elasticity of trimethylene carbonate and lactide (including L- lactides, D- lactides, its blend or lactic acid copolymer) Precursor copolymer is (preferably with about 30:70 to about 70:The mol ratio of 30 trimethylene carbonates and lactide) and their blending Thing.Elastomer copolymer can be glycolide and the copolymer of 6-caprolactone.Alternatively, elastomer copolymer is third The copolymer of lactide and 6-caprolactone.

Be published on November nineteen ninety-five 21 it is entitled " ELASTOMERIC MEDICAL DEVICE " United States Patent (USP) 5, 468,253 and it is published in entitled " the FOAM BUTTRESS FOR STAPLING APPARATUS " on December 4th, 2001 United States Patent (USP) 6,325,810 disclosure be each incorporated by reference in its entirety accordingly herein.

Tissue thickness compensation part can include emulsifying agent.The example of emulsifying agent may include but be not limited to water-soluble polymer, all Such as polyvinyl alcohol (PVA), vinylpyrrolidone (PVP), polyethylene glycol (PEG), polypropylene glycol (PPG), pluronic (PLURONICS), tween (TWEENS), polysaccharide and combinations thereof.

Tissue thickness compensation part can include surfactant.The example of surfactant may include but be not limited to polypropylene It is acid, methylase, methylcellulose, ethyl cellulose, propyl cellulose, hydroxy ethyl cellulose, carboxy methyl cellulose, poly- Oxygen ethene cetyl ether, polyoxyethylene lauryl ether, polyoxyethylene octyl ether, NONIN HS 240, polyoxyethylene Oleyl ether, Tween 20, polyoxyethylene stearyl base ether, ethylene nonyl phenyl ether, two Poly- (ethyleneoxy) ethanol of alkyl phenoxy and poloxamer.

Polymer composition may include pharmaceutically active agents.The pharmaceutical activity of the releasable therapeutically effective amount of polymer composition Agent.When polymer composition is desorbed/absorbed, pharmaceutically active agents can be released.Pharmaceutically active agents can be released to fluid such as Flow through above polymer composition or through in the blood of polymer composition.The example of pharmaceutically active agents can include but not limit In styptic and medicine, such as, for example, fibrin, fibrin ferment and oxidized regenerated cellulose (ORC)；Anti-inflammatory agent, such as, For example, Diclofenac, aspirin, naproxen, sulindac and hydrocortisone；Antibiotic and antimicrobial or preparation, it is all Such as, for example, triclosan, silver ion, ampicillin, gentamicin, polymyxin B, chloramphenicol；And cancer therapy drug, such as, For example, cis-platinum, mitomycin, adriamycin.

Polymer composition may include hemostatic material.Tissue thickness compensation part may include hemostatic material, and it includes poly- (breast Acid), poly- (glycolic), poly- (butyric ester), poly- (caprolactone), poly- (dioxanone), polyoxyalkylene, copolymerization (ether- Ester), collagen, gelatin, fibrin ferment, fibrin, fibrinogen, FN, elastin laminin, albumin, hemoglobin, Ovalbumin, polysaccharide, hyaluronic acid, chondroitin sulfate, HES, hydroxyethyl cellulose, cellulose, oxycellulose, Hydroxypropyl cellulose, carboxyethyl cellulose, carboxymethyl cellulose, chitin, chitosan, agarose, maltose, malt Magma essence, alginate, clotting factor, methacrylate, polyurethane, acrylate, platelet agonist, vessel retraction Agent, alum, calcium, RGD peptide, protein, protamine sulfate, ε-aminocaproic acid, ferric sulfate, ferric subsulfate, iron chloride, zinc, Zinc chloride, aluminium chloride, aluminum sulfate, aluminum acetate, permanganate, tannic acid, bone wax, polyethylene glycol, fucosan and they Combination.The feature of tissue thickness compensation part can be haemostatic properties.

The polymer composition of tissue thickness compensation part is characterised by such as percent porosity, hole size, and/or hard Degree.Polymer composition can have such as about 30% to about 99% percent porosity by volume.Polymer composition There can be such as about 60% to about 98% percent porosity by volume.Polymer composition can have for example by volume The percent porosity of meter about 85% to about 97%.Polymer composition may include such as by weight about 70% PLLA By weight about 30% PCL, and may include such as about 90% porosity by volume.For example, therefore polymerizeing Compositions will include by volume about 10% copolymer.Polymer composition may include such as by weight about 65% PGA and by weight about 35% PCL, and can have such as by volume about 93% to by volume about 95% Percent porosity.Polymer composition may include to be more than 85% porosity by volume.Polymer composition can have example Such as about 5 microns to about 2000 microns of hole size.Polymer composition can have for example between about 10 microns to about Hole size between 100 microns.For example, polymer composition can for example include PGA and PCL copolymer.Polymer composition There can be the hole size for example between about 100 microns to about 1000 microns.For example, polymer composition can be wrapped for example Include PLLA and PCL copolymer.

According to some aspects, the hardness of polymer composition can represent that the Shore hardness can be defined as with Shore hardness The tolerance of the permanent indenture to material such as determined by sclerometer.In order to assess the durometer value of given material, According to entitled " Standard Test Method for Rubber Property-Durometer Hardness " ASTM Program D2240-00, material is applied pressure to hardness head pressure feet, and its full text is hereby incorporated herein by.Can will be hard Degree meter pressure head pin is administered to material and continues enough a period of times, such as 15 seconds, for example, wherein reading is read from suitable scale Take.According to scale type used, when pressure head pin completely penetrates through material, reading 0 can be obtained, and when material is not pierced When, reading 100 can be obtained.The reading dimensionless.Can be for example according to ASTM D2240-00 according to any suitable scale such as A Class and/or OO classes scale determine hardometer.The polymer composition of tissue thickness compensation part may have about 4A to about 16A Shore A Hardness value, the Shore A Hardness value is for example in about 45OO to about 65OO Shore OO scopes.For example, polymer group Compound may include such as PLLA/PCL copolymers or PGA/PCL copolymers.The polymer composition of tissue thickness compensation part can have There is the Shore A Hardness value less than 15A.The polymer composition of tissue thickness compensation part can have the Xiao A hardness less than 10A Value.The polymer composition of tissue thickness compensation part can have the Shore A Hardness value less than 5A.Polymeric material can have for example About 35OO to about 75OO Shore OO composition values.

Polymer composition can have at least two in the above-mentioned characteristic identified.Polymer composition can have above-mentioned At least three kinds in the characteristic identified.Polymer composition can have such as 85% to 97% porosity, 5 micro- by volume Hole size and 4A to 16A Shore A Hardness value and 45OO to 65OO shore OO hardness value of the rice to 2000 microns.Polymerization Compositions may include 70 weight % PLLA polymer composition and 30 weight % PCL polymer composition；Institute Stating polymer composition has such as 90% porosity, 100 microns to 1000 microns of hole size and 4A to 16A by volume Shore A Hardness value and 45OO to 65OO shore OO hardness value.Polymer composition may include that 65 weight % PGA's is poly- Polymer composition and 35 weight % PCL polymer composition；The polymer composition have for example by volume from The Shore A Hardness value and 45OO of 93% to 95% porosity, 10 microns to 100 microns of hole size and 4A to 16A are arrived 65OO shore OO hardness value.

Tissue thickness compensation part may include the material that can be extended.As described above, tissue thickness compensation part may include do not pressing The compression material extended when contracting or deployment.Tissue thickness compensation part may include to be formed in situ from expansion material.Tissue thickness is mended Repay part can comprising at least one precursor, at least one precursor be selected as when with other precursors, water and/or body fluid extremely Can spontaneous crosslinking during a kind of few contact.According to the present invention, the first precursor can contact other one or more precursors can be expanded with being formed Open up and/or swellable tissue thickness compensation part.Tissue thickness compensation part can include the swollen composition of fluid-soluble, such as water Swellable composition.Tissue thickness compensation part can include aqueous gel.

Tissue thickness compensation part can include the biodegradable foam with packaging part, and the packaging part is embedded comprising it The dried hydrogel particle or granule entered.The packaging part being not intended to be limited in any particular theory, foam can be by as follows Mode is formed：The aqueous solution of hydrogel precursor and the organic solution of biocompatible materials is set to contact to form foam.The aqueous solution Micella can be formed with organic solution.The aqueous solution and organic solution can be encapsulated by drying dried hydrogel particle in foam or Granula.For example, hydrogel precursor (such as hydrophilic polymer) is dissolvable in water water to form the dispersion of micella.The aqueous solution can connect Touch the organic solution of the dioxane comprising poly- (glycolic) and polycaprolactone.The aqueous solution and organic solution can be lyophilized from And formed with the biodegradable foam for disperseing dried hydrogel particle therein or granule.It is not intended to be limited to any Particular theory, it is believed that micelle forma-tion packaging part, the packaging part have be scattered in dried hydrogel particle in foaming structure or Granule.The packaging part is rupturable, and dried hydrogel particle or granule can contact fluid (such as body fluid) and extend.

Optionally, as described above, tissue thickness compensation part may include original depth and extension thickness.Tissue thickness compensates The original depth of part may be, for example, that it extends about the 0.01% of about the 0.001% of thickness, its extension thickness, its extension thickness About 0.1%, its extend thickness about 1%, its extend thickness about 10%, its extend thickness about 20%, its Extend thickness about 30%, its extend thickness about 40%, its extend thickness about 50%, its extend thickness about 60%th, it extends about the 70% of thickness, about the 80% of its extension thickness, and/or about the 90% of its extension thickness.Tissue The extension thickness of thickness compensation part can it is for example thicker than its original depth about 2 times, about 5 times, about 10 times, about 50 times, it is big About 100 times, about 200 times, about 300 times, about 400 times, about 500 times, about 600 times, about 700 times, about 800 Again, about 900 times, and/or about 1000 times.The original depth of tissue thickness compensation part can be up to its extend thickness 1%, Up to it extends the 5% of thickness, up to it extends the 10% of thickness and up to it extends the 50% of thickness.Tissue The extension thickness of thickness compensation part is thick than its original depth by least 50%, thicker than its original depth by least 100%, more initial than its Thickness thickness at least 300% and thicker than its original depth by least 500%.As described above, in various scenarios, as above-mentioned Result, tissue thickness compensation part can occupy any gap in nail retention region.

As described above, tissue thickness compensation part can include hydrogel.Hydrogel may include homopolymer hydrogel, copolymer Hydrogel, multipolymer hydrogel, interpenetrating polymer hydrogel and combinations thereof.Hydrogel may include microgel, receive Rice gel and combinations thereof.Hydrogel can generally include the hydrophilic polymer network that can be absorbed and/or keep fluid. Hydrogel may include noncrosslinking hydrogel, the hydrogel of crosslinking and combinations thereof.Hydrogel may include chemical cross-linking agent, Physical crosslinking agent, hydrophobic patch and/or the undissolved fragment of water.Hydrogel can be crosslinked and/or poly- by polymerisation, small molecule Compound-crosslinked polymer is chemically crosslinked.Hydrogel can pass through ionic interaction, hydrophobic interaction, Hydrogenbond phase Interaction, stereocomplex and/or supramolecular chemistry are physically crosslinked.Because crosslinking agent, hydrophobic patch and/or water are undissolved Fragment, hydrogel can be substantially undissolved, but due to absorbing and/or keeping fluid, hydrogel is expansible and/or is swelled. Precursor can be crosslinked with endogenous material and/or tissue.

Hydrogel may include enviromental sensitive hydrogel (ESH).ESH may include have the fluid related to environmental condition molten The material of swollen property characteristic.Environmental condition may include but be not limited to the physical condition in operative site, biotic factor and/or chemical bar Part.For example, in response to temperature, pH, electric field, ionic strength, enzyme and/or chemical reaction, electricity and/or Neural stem cell, and other physiology And environment variable, hydrogel it is swellable or shrink.ESH may include polyfunctional acrylate, hydroxyethyl methacrylate (HEMA), the monomer of elastomeric acrylate or correlation.

Tissue thickness compensation part comprising hydrogel may include in non-synthetic materials described above and synthetic material extremely Few one kind.Hydrogel may include synthesis hydrogel and/or non-synthetic hydrogel.Tissue thickness compensation part may include multiple layers.It is many Individual layer may include porous layer and/or non-porous layer.For example, tissue thickness compensation part may include non-porous layer and porous layer.And for example, organize Thickness compensation part may include the porous layer between the first non-porous layer and the second non-porous layer.And for example, tissue thickness compensation part may include Non-porous layer between first porous layer and the second porous layer.Non-porous layer and porous layer can be relative to nail bin and/or the tables of anvil block Face is positioned in any order.

The example of non-synthetic materials may include but be not limited to albumin, alginates, carbohydrate, casein, cellulose, Chitin, chitosan, collagen, blood, glucan, elastin laminin, fibrin, fibrinogen, gelatin, liver Element, hyaluronic acid, keratin, protein, serum and starch.Cellulose may include hydroxyethyl cellulose, oxycellulose, oxidation Regenerated cellulose (ORC), hydroxypropyl cellulose, carboxyethyl cellulose, carboxymethyl cellulose and combinations thereof.Collagen can be wrapped Include bovine pericardium.Carbohydrate may include polysaccharide, such as lyophilized polysaccharide.Protein may include glycoprotein, proteoglycans and Combinations thereof.

The example of synthetic material may include but be not limited to poly- (lactic acid), poly- (glycolic), poly- (butyric ester), poly- (phosphine Piperazine), polyester, polyethylene glycol, PEO, PEO-polypropylene oxide copolymers, copolymerization oxirane, polyoxygenated Alkene, polyacrylamide, poly hydroxy ethyl acrylate, PVP, polyvinyl alcohol, poly- (caprolactone), poly- (dioxy Heterocycle hexanone), polyacrylic acid, poly- acetic acid esters, polypropylene, aliphatic polyester, glycerine, poly- (amino acid), copolymerization (ether-ester), poly- grass Sour alkylidene diol ester, polyamide, poly- (iminocarbonic ester), polyoxy acid ester, poe, polyphosphazene and their group Close.It conventional method can be used synthetically to prepare above non-synthetic materials, for example, synthesize hyaluronic acid.

Hydrogel can be made up of one or more hydrogel precursors.The precursor may include monomer and/or macromonomer.Water Gel precursors may include electrophilic body functional group and/or nucleophile electrophilic body functional group.In general, electrophilic body can be anti-with nucleophile Should be to form chemical bond.Term " functional group " used herein refers to the electrophilic group for being capable of reacting with each other to form chemical bond Or nucleophilic group.It is sub- that the example of electrophilic functional group may include but be not limited to n-hydroxysuccinimide (" NHS "), sulfosuccinic acyl Amine, carbonyl dimidazoles, sulfonic acid chloride, aryl halide, sulfosuccinic ester, N-hydroxy-succinamide ester, succinimide ester, it is all Such as succinimidyl succinate and/or succinimidyl propionate, isocyanide ester, thiocyanates, carbodiimides, benzo three Azoles carbonic ester, epoxide, aldehyde, maleimide, imino-ester, combinations thereof etc..Electrophilic functional group may include amber Amber imide ester.The example of nucleophilic functional group may include but be not limited to-NH₂、-SH、-OH、-PH₂With-CO-NH-NH₂。

Hydrogel can be formed by single precursor or multiple precursors.Hydrogel can be formed by the first precursor and the second precursor.The One hydrogel precursor and the second hydrogel precursor can be in situ in contact or form hydrogel in vivo.Hydrogel precursor typically may be used Refer to polymer, functional group, macromolecular, small molecule and/or reaction can be participated in form the crosslinking agent of hydrogel.Precursor may include Such as homogeneous solution, the uneven or solution that is separated in appropriate solvent, such as water or buffer solution.The pH of buffer solution can be E.g., from about 8 to about 12, such as about 8.2 to about 9.The example of buffer solution may include but be not limited to borate buffer solution.Precursor can be In emulsion.According to the present invention, the first precursor can be with the second precursors reaction formation hydrogel.First precursor with the second precursor thereof When spontaneous can be crosslinked.According to the present invention, first group of electrophilic functional group on the first precursor can be with second on the second precursor group parent Core functional group reactionses.When during precursor is blended in the environment for allowing reaction (for example, when to pH, temperature and/or related solvent), Functional group can react with each other to form covalent bond.It is preceding during the other precursors reactions of at least some and more than one in precursor Body can turn into crosslinking.

Tissue thickness compensation part may include at least one monomer, and the monomer is selected from 3- sulfopropyl acrylic acid sylvite (" KSPA "), PAA (" NaA "), N- (three (hydroxymethyl) methyl) acrylamides (" triacryl ") and 2- acryloyls Amine -2- methyl isophthalic acids-propane sulfonic acid (AMPS).Tissue thickness compensation part may include copolymer, and the copolymer includes two or more Selected from KSPA, NaA, triacryl, AMPS monomer.Tissue thickness compensation part may include to derive from KSPA, NaA, three propylene The homopolymer of acyl group, AMPS.Tissue thickness compensation part may include hydrophilically modified monomer that can be with its copolymerization.Hydrophilically modified list Body may include methyl methacrylate, butyl acrylate, cyclohexyl acrylate, styrene, styrene sulfonic acid.

Tissue thickness compensation part may include crosslinking agent.Crosslinking agent may include low molecule amount two or polyvinyl crosslinking agents, such as Glycol diacrylate or dimethylacrylate, two, three or tetravinyl-glycol diacrylate or dimethyl allene Acid esters, pi-allyl (methyl) acrylate, C₂-C₈- alkylidene diacrylate or dimethylacrylate, divinyl ether, diethyl Alkene sulfone, two and trivinylbenzene, trimethylolpropane trimethacrylate or trimethyl acrylic ester, tetramethylol methane tetraacrylate Or tetramethyl acrylate, bisphenol a diacrylate or dimethylacrylate, methylene-bisacrylamide or dimethyl allene Acid amides, ethylene bisacrylamide or ethene DMAA, triallyl phthalate or diallyl phthalate third Ester.Crosslinking agent may include N, N'- methylene-bisacrylamide (" MBAA ").

Tissue thickness compensation part may include acrylate and/or methacrylate function hydrogel, biocompatibility light At least one of initiator, alkyl-cyanoacrylate, isocyanate-functional macromonomer, optionally include amine function Macromonomer, succinimide ester function macromonomer, optionally include amine and/or Mercaptofunctional macromonomer, ring Epoxide function macromonomer, optionally include the mixing of amine function macromonomer, protein and/or polypeptide and aldehyde cross-linking agent Carbodiimides, anion polysaccharide and the polyvalent cation of thing, Geniposide (Genipin) and water dissolvable.

Tissue thickness compensation part may include undersaturated organic acid monomer, acrylic acid substituted alcohols and/or acrylamide.Tissue Thickness compensation part may include methacrylic acid, acrylic acid, glyceryl acrylate, glycerol methacrylate, 2- hydroxyethyl first Base acrylate, 2- hydroxy-ethyl acrylates, 2- (dimethyl aminoethyl) methacrylate, NVP, first Base acrylamide and/or N, N- DMAA are poly- (methacrylic acid).

Tissue thickness compensation part may include reinforcing material.Reinforcing material may include above-described non-synthetic materials and synthesis At least one of material.Reinforcing material may include collagen, gelatin, fibrin, fibrinogen, elastin laminin, angle egg In vain, albumin, hydroxyethyl cellulose, cellulose, oxycellulose, hydroxypropyl cellulose, carboxyethyl cellulose, carboxymethyl cellulose Element, chitin, chitosan, alginates, poly- (lactic acid), poly- (glycolic), poly- (butyric ester), poly- (phosphine piperazine), poly- It is ester, polyethylene glycol, polyoxyalkylene, polyacrylamide, poly hydroxy ethyl acrylate, polyvinylpyrrolidone, polyvinyl alcohol, poly- It is (caprolactone), poly- (dioxanone), polyacrylic acid, poly- acetic acid esters, pla-pcl, polypropylene, aliphatic polyester, glycerine, poly- (amino acid), copolymerization (ether-ester), poly- oxalic acid alkylidene diol ester, polyamide, poly- (iminocarbonic ester), poly- oxalic acid alkylidene Diol ester, polyoxy acid ester, poe, polyphosphazene and combinations thereof.

Tissue thickness compensation part may include the layer for including reinforcing material.The porous layer of tissue thickness compensation part and/or non-porous Layer may include reinforcing material.For example, porous layer may include reinforcing material and non-porous layer may not include reinforcing material.Enhancement layer can Including the internal layer between the first non-porous layer and the second non-porous layer.Enhancement layer may include the outer layer of tissue thickness compensation part.Enhancement layer It may include the outer surface of tissue thickness compensation part.

Reinforcing material may include mesh sheet, monofilament, multifilament weave fabric, fiber, pad, felt, particle and/or pulvis.Reinforcing material In the layer that can be coupled to tissue thickness compensation part.Reinforcing material can be coupled at least one of non-porous layer and porous layer.Can Using routine techniques (such as be knitted, weave, tatting and/be knitted or to form the mesh sheet including reinforcing material.

According to the present invention, a variety of reinforcing materials can be orientated with random direction and/or common direction.Common direction may be, for example, It is one of parallel with staple line and vertical with staple line.For example, monofilament and/or multifilament weave fabric can be with random directions and/or common Direction is orientated.Monofilament and multifilament weave fabric can be associated with non-porous layer and/or porous layer.Tissue thickness compensation part may include in nothing Many reinforcing fibers being orientated in aperture layer with random direction.Tissue thickness compensation part may include to take with common direction in non-porous layer To many reinforcing fibers.

Fiber can form non-woven material, for example pad and felt.Fiber can have any appropriate length, such as from 0.1mm To 100mm and 0.4mm to 50mm.Reinforcing material can be ground into powder.Powder can have the grain for example from 10 microns to 1 centimetre Degree.Powder can be coupled in tissue thickness compensation part.

Tissue thickness compensation part can be formed in situ.Hydrogel can be formed in situ.Tissue thickness compensation part can by covalently from Son and/or hydrophobic bond are formed in situ.(non-covalent) crosslinking of physics can be mutual by complexing, hydrogen bonding, desolvation, Van der Waals Effect, ionic bonding and combinations thereof cause.(covalent) crosslinking of chemistry can be by including appointing in following a variety of mechanism What one kind is realized：Radical polymerization, condensation polymerization, anion or cationic polymerization, progressively polymerization, electrophilic-necleophilic reaction with And combinations thereof.

Optionally, being formed in situ for tissue thickness compensation part may include to make two or more precursors reactions, the precursor It is physically separated from until situ contact and/or environmental condition is reacted so as to react with each other to form hydrogel.It is in situ Polymerizable polymer can be prepared by precursor, and the precursor can be reacted with operative site formation polymer.Tissue thickness compensates Part can be formed by the cross-linking reaction of precursor in the original location.Precursor may include that the shape in situ tissue thickness compensation part can be triggered Into polymerisation initiator.Tissue thickness compensation part can be activated and be formed before cross-linked hydrogel when can be included in application Body.Being formed in situ for tissue thickness compensation part may include to activate at least one precursor to form chemical bond, so that it is thick to form tissue Spend compensating part.Optionally, activation can be by the change in operative site physical condition, biotic factor and/or electrochemical conditions come real Existing, the condition, which changes, includes but is not limited to temperature, pH, electric field, ionic strength, enzyme and/or chemical reaction, electricity and/or magnetic thorn Swash, and other physiological and environment variables.Precursor in body external contact and can introduce operative site.

Tissue thickness compensation part may include one or more packaging parts or unit, and it can store at least one group wherein Point.Packaging part can store hydrogel precursor wherein.For example, packaging part can store two components wherein.Packaging part energy It is enough to store the first hydrogel precursor and the second hydrogel precursor wherein.First packaging part can store the first hydrogel wherein Precursor and the second packaging part can store the second hydrogel precursor wherein.As described above, packaging part can be aligned with nail leg or At least substantially alignment is so as to the puncture packaging part when nail leg contacts packaging part and/or in other words ruptures packaging part.Work as portion During administration's nail, the packaging part can be compressed, conquassation, is collapsed and/or is in other words ruptured.After packaging part rupture, store therein Component can flow out packaging part.Store component therein and can contact other components, the layer and/or tissue of tissue thickness compensation part.Its He can flow out at component from identical or different packaging part, provided in the layer of tissue thickness compensation part and/or pass through clinician It is provided in operative site.As above-described result, the component being stored in packaging part can provide tissue thickness compensation part Extend and/or be swelled.

Tissue thickness compensation part may include the layer for including packaging part.Packaging part may include the space associated with layer, pit, Dome, pipe and combinations thereof.The packaging part may include the space in layer.Layer may include that mutual two can be attached to Layer, wherein packaging part can be defined between two layers.Packaging part may include the dome in layer surface.For example, packaging part is at least A part can be positioned in the dome upwardly extended from layer.Packaging part may include the pit formed in layer.The of packaging part A part may include dome, and the Part II of packaging part may include pit.Packaging part may include the pipe being embedded in layer.The pipe It may include non-synthetic materials as described herein and/or synthetic material, such as PLA.Tissue thickness compensation part may include biological to inhale The foam of receipts, such as ORC, the bioabsorbable foam include the PLA pipes being embedded, and the pipe can encapsulate such as water Gel.Packaging part may include mutual unconnected separate unit.One or more of packaging part can be via for example extending through Layer one or more paths, conduit, and/or passage and be in fluid communication with each other.

The release rate of component from packaging part can be controlled by as described below：The thickness of such as tissue thickness compensation part, The part of tissue thickness compensation part, the size of component, the hydrophily of component, and/or the physics and/or change in component Learn interaction, the part, and/or surgical instruments of tissue thickness compensation part.Layer may include one or more light filling bars or weak Change part (such as local perforations), such as one or more of light filling bars or weakening part can be conducive to incised layer and make packaging part Rupture.Local perforations can not extend completely through layer, and in some cases, perforation may extend entirely through layer.

Optionally, anvil block may include tissue thickness compensation part, and the tissue thickness compensation part includes having at least one micro- The encapsulating component of spherolite.Tissue thickness compensation part may include the packaging part with the first encapsulating component and the second encapsulating component. Tissue thickness compensation part may include the packaging part with the first microsphere particles and the second microsphere particles.

Tissue thickness compensation part can be adapted to be used together with surgical instruments.As described above, tissue thickness compensation part can be with nail Storehouse and/or anvil block are associated.Tissue thickness compensation part may be configured to be adapted for engagement with any shape, the size of nail bin and/or anvil block And/or dimension.As described herein, tissue thickness compensation part can be releasably attached to nail bin and/or anvil block.In sewing process Before and during sewing process, tissue thickness compensation part can keep tissue thickness compensation part and nail bin and/or anvil The tactile any mechanical and/or chemical mode of seated connection is attached to nail bin and/or anvil block.Nail pierce through tissue thickness compensation part with Afterwards, it can be removed from nail bin and/or anvil block or discharge tissue thickness compensation part.When nail bin and/or anvil block move away from tissue thickness When spending compensating part, it can be removed from nail bin and/or anvil block or discharge tissue thickness compensation part.

Referring now to Figure 14, nail bin (such as nail bin 10000) for example may include support section 10010 and compressible tissue Thickness compensation part 10020.Referring now to Figure 16-Figure 18, support section 10010 may include platform surface 10011 and be limited to branch Multiple nail cavities 10012 in support part point 10010.The size of each nail cavity 10012 can for example be set to and can be removable wherein Followed closely except ground is stored, such as follow closely 10030.Nail bin 10000 may also include multiple staple drivers 10040, when nail 10030 and staple drivers 10040 be in its non-firing position when, each staple drivers can support one or more nails 10030 in nail cavity 10012.Example Such as, referring primarily to Figure 22 and Figure 23, each staple drivers 10040 may include for example one or more supports or groove 10041, the branch Frame or groove support nail and can limit the relative motion between nail 10030 and staple drivers 10040.Referring again to Figure 16, nail bin 10000 may also include nail percussion sliding part 10050, and the nail percussion sliding part can move to nail from the proximal extremity 10001 of nail bin The distal end 10002 in storehouse, so as to successively by staple drivers 10040 and nail 10030 from its non-firing position to being positioned in nail The anvil block on the opposite of storehouse 10000 is lifted.Referring primarily to Figure 16 and Figure 18, each nail 10030 may include base portion 10031 and from base portion One or more legs 10032 of 10031 extensions, wherein each nail can be at least one of for example substantially U-shaped and basic V-shaped. Nail 10030 is enabled to when following closely 10030 in its non-firing position, and the top of nail leg 10032 is relative to support section 10010 Platform surface 10011 be recessed.Nail 10030 is enabled to when following closely 10030 in its non-firing position, the top of nail leg 10032 The platform surface 10011 relative to support section 10010 is held to flush.Nail 10030 is enabled to when nail 10030 is not fired in it During position, the top of nail leg 10032 or at least certain part of nail leg 10032 extend to the platform surface of support section 10010 10011 tops.In this case, when following closely 10030 in its non-firing position, nail leg 10032 may extend into simultaneously quilt It is embedded into tissue thickness compensation part 10020.For example, nail leg 10032 can for example extend to the top of platform surface 10011 about 0.075".Nail leg 10032 can for example extend between about 0.025 " and about 0.125 " of the top of platform surface 10011 away from From.Further described above, tissue thickness compensation part 10020 may include such as about 0.08 " and about 0.125 " it Between uncompressed thickness.

In use, as further described above and referring primarily to Figure 31, anvil block such as anvil block 10060 can for example be transported Move the closing position relative with nail bin 10000.As described in more detail below, anvil block 10060 will can be organized against tissue thickness Compensating part 10020 positions and for example presses to tissue thickness compensation part 10020 platform surface 10011 of support section 10010. Once anvil block 10060 is appropriately positioned, then nail 10030 can be disposed, it is same as shown in figure 31.Optionally, as described above, nail is hit Hair sliding part 10050 can be moved from the distal end 10002 of proximal extremity 10001 of nail bin 10000, as shown in figure 32.Work as cunning When moving part 10050 is pushed into, sliding part 10050 can contact staple drivers 10040 and in nail cavity 10012 by staple drivers 10040 are lifted up.Sliding part 10050 and staple drivers 10040 can each include one or more slopes or inclined-plane, this Or multiple slopes or inclined-plane can cooperate so that staple drivers 10040 are moved upwards from its non-firing position.For example, with reference to Figure 19- Figure 23, each staple drivers 10040 may include at least one inclined-plane 10042, and sliding part 10050 may include it is one or more Inclined-plane 10052, it is enabled to when sliding part 10050 is pushed into nail bin towards distal side, and inclined-plane 10052 is on inclined-plane 10042 Lower slider.When staple drivers 10040 are lifted up in its respective nail cavity 10012, staple drivers 10040 will can be followed closely 10030 are lifted up so that nail 10030 can be exposed by the opening in nail platform 10011 from its nail cavity 10012.In example During property percussion sequence, referring primarily to Figure 25-Figure 27, sliding part 10050 contact stud 10030a first and can start to follow closely 10030a is lifted up.When sliding part 10050 is further promoted towards distal side, sliding part 10050 can start that 10030b will be followed closely, 10030c, 10030d, 10030e and 10030f and any other follow-up nail are lifted in order.As shown in figure 27, sliding part 10050 can drive up nail 10030 so that the leg 10032 of nail is contacted with relative anvil block, is deformed into desired shape, and And be shot up from support section 10010.In various scenarios, as a part for percussion sequence, sliding part 10030 can simultaneously by The motion upwards of multiple nails.Percussion sequence shown in reference picture 27, nail 10030a and 10030b has moved to its complete firing position And it is shot up from support section 10010, during nail 10030c and 10030d is in by percussion and by least in part It is contained in support section 10010, and follows closely 10030e and 10030f and is still within its non-firing position.

As described above and referring to Figure 33, when following closely 10030 in its non-firing position, the nail leg 10032 of nail 10030 can prolong Reach the top of platform surface 10011 of support section 10010.With further reference to the percussion sequence shown in Figure 27, nail 10030e and 10030f is illustrated at its non-firing position, and its nail leg 10032 extends to the top of platform surface 10011 and extended to In tissue thickness compensation part 10020.When following closely 10030 in its non-firing position, the top of nail leg 10032 or nail leg 10032 Any other part convex may not wear the top tissue contacting surface 10021 of tissue thickness compensation part 10020.Such as Figure 27 institutes Show, when nail 10030 moves to its firing position from its non-firing position, the top of nail leg convex can wear tissue contacting surface 10032.The top of nail leg 10032 may include the sharp top that can cut and penetrate tissue thickness compensation part 10020.Tissue Thickness compensation part 10020 may include multiple holes, and the multiple hole can receive nail leg 10032 and allow nail leg 10032 relative Slided in tissue thickness compensation part 10020.Support section 10010 may also include the multiple guiding extended from platform surface 10011 Device 10013.Guider 10013 can be positioned so that the nail cavity opening of neighbouring platform surface 10011 so that nail leg 10032 can be at least Partly supported by guider 10013.Guider 10013 can be positioned in the proximal extremity and/or distal end of nail cavity opening Place.According to the present invention, the first guider 10013 can be positioned in the first end of each nail cavity opening, and the second guider 10013 can be positioned in the second end of each nail cavity opening so that the sustainable nail 10030 of each first guider 10013 First nail leg 10032, and the second nail leg 10032 of the sustainable nail of each second guider 10013.Referring to Figure 33, each lead It may include groove or slit to device 10013, such as groove 10016, such as nail leg 10032 can be slidably received in the groove In 10016.Optionally, each guider 10013 may include to extend and may extend into tissue thickness's benefit from platform surface 10011 Repay anti-skid stud, projection, and/or the spike in part 10020.As described in more detail below, anti-skid stud, projection, and/or spike can subtract Relative motion between cell thickness compensation part 10020 and support section 10010.The top of nail leg 10032 can be positioned in It can not extended on the top surface of guider 10013 in guider 10013 and when following closely 10030 and being in its non-firing position Side.For example, guider 10013 can limit guiding height, and nail 10030 can not extended to when being not at its non-firing position Above the guiding height.

According to the present invention, tissue thickness compensation part such as tissue thickness compensation part 10020 for example can be by single material piece structure Into.Tissue thickness compensation part may include continuous sheet, and the continuous sheet can cover the whole top horizontal of support section 10010 Platform surface 10011, or alternatively, covering is less than whole platform surface 10011.Material piece can cover support section Nail cavity opening in 10010, but alternatively, material piece may include can be aligned with nail cavity opening or at least portion Divide the opening of alignment.According to the present invention, tissue thickness compensation part can be made up of multilayer material.Referring now to Figure 15, tissue thickness Compensating part may include compressible core and the wrappage around compressible core.Wrappage 10022 can be by compressible core releasedly Remain to support section 10010.For example, support section 10010 may include one or more protuberances for example from its extension, it is all Such as protuberance 10014 (Figure 18), the protuberance can be received in one or more holes and/or slit, be such as limited to wrappage In hole 10024 in 10022.Protuberance 10014 and hole 10024 enable to protuberance 10014 to keep wrappage 10022 To support section 10010.The end of protuberance 10014 for example can be deformed by heating processing, to expand protuberance 10014 End, and therefore limitation wrappage 10022 and support section 10010 between relative motion.Wrappage 10022 may include One or more perforation 10025, it can be conducive to discharging wrappage 10022 from support section 10010, as shown in figure 15.It is existing Referring to Figure 24, tissue thickness compensation part may include wrappage 10222, and the wrappage includes multiple holes 10223, its mesopore 10223 can be aligned with the nail cavity opening in support section 10010 or at least partly be aligned.The core of tissue thickness compensation part can also be wrapped Include the hole for being aligned or being at least partly aligned with the hole 10223 in wrappage 10222.Alternatively, tissue thickness compensates The core of part may include continuous main body and may extend into below hole 10223 so that in continuous main body covering platform surface 10011 Nail cavity opening.

Optionally, as described above, tissue thickness compensation part may include to be used to compressible core releasably holding support The wrappage of part 10010.For example, with reference to Figure 16, nail bin may also include retainer fixture 10026, and the retainer fixture can Suppress wrappage and compressible core is prematurely separated with support section 10010.Optionally, each retainer fixture 10026 can be wrapped The hole 10028 of the protuberance 10014 extended from support section 10010 can be received by including so that retainer fixture 10026 can be protected Hold support section 10010.Retainer fixture 10026 can each include at least one flat of bottom 10027, and the flat of bottom can Extend to below support section 10010 and in the inner support of support section 10010 and keep staple drivers 10040.As described above, Tissue thickness compensation part can be removably attachable to support section 10010 by nail 10030.More particularly, as also described above, When following closely 10030 in its non-firing position, the leg of nail 10030 may extend into tissue thickness compensation part 10020, and therefore will Tissue thickness compensation part 10020 releasably holds support section 10010.The leg of nail 10030 can its corresponding nail cavity 10012 side wall contact, wherein, due to the friction between nail leg 10032 and side wall, nail 10030 and tissue thickness compensation part 10020 can be maintained at appropriate location, until nail 10030 is disposed from nail bin 10000.After nail 10030 is disposed, tissue is thick Degree compensating part 10020 can be trapped in nail 10030 and is kept against the tissue T of suture.Beaten when anvil block is subsequently moved into Open position is to discharge during tissue T, and support section 10010 is movable away from the tissue thickness compensation part 10020 for having been secured to tissue. It can be used adhesive that tissue thickness compensation part 10020 is removedly remained into support section 10010.Two parts can be used to glue Mixture, wherein, the Part I of adhesive can be placed on platform surface 10011, and the Part II of adhesive can quilt It is placed into tissue thickness compensation part 10020 so that when tissue thickness compensation part 10020, which is close to platform surface 10011, places, Part I can contact Part II to enable adhesive and tissue thickness compensation part 10020 is separably bonded into supporting part Divide 10010.Optionally, it can be used any other suitable method that tissue thickness compensation part is separably remained to the branch of nail bin Support part point.

Further described above, sliding part 10050 proximally can be advanced to distal end in end 10001 10002 are accommodated in all nails 10030 in nail bin 10000 with complete deployment.Referring now to Figure 56-Figure 60, sliding part 10050 Pushed away in longitudinal cavity 10016 that can be in support section 10010 by the knife bar 10052 of firing member or surgical stapling device towards distal side Enter.In use, nail bin 10000 can be inserted into the staple cartridge channel in the jaw of surgical stapling device, for example staple cartridge channel 10070 It is interior, and firing member 10052 can be advanced to and be contacted with sliding part 10050, as shown in figure 56.When sliding part 10050 is by hitting Hair component 10052 towards distal side promotes when, sliding part 10050 can contact the staple drivers or driver 10040 of recent side, and general Nail 10030 is fired or projected from warehouse 10010, as described above.As shown in figure 56, firing member 10052 may also include cutting blade 10053, when nail 10030 is fired, the cutting blade can be pushed into by the cutter slit in support section 10010 towards distal side.According to The present invention, corresponding cutter slit can extend across the anvil block for being positioned in the opposite of nail bin 10000 so that cutting blade 10053 can be in anvil Extend and cut tissue and the tissue thickness compensation part being positioned in therebetween between seat and support section 10010.In various situations In, sliding part 10050 can be promoted by firing member 10052 towards distal side, until sliding part 10050 reaches the distal side of nail bin 10000 End 10002, as shown in figure 58.Now, firing member 10052 can proximally bounce back.Sliding part 10050 can be with firing member 10052 proximally bounce back, but referring now to Figure 59, when firing member 10052 bounces back, sliding part 10050 can be left on nail In the distal end 10002 in storehouse 10000.Once firing member 10052 fully bounces back, anvil block can be opened again, and tissue is thick Degree compensating part 10020 can be separated with support section 10010, and exhaust the remaining non-implanted portion of nail bin 10000, including Support section 10010, can be removed from staple cartridge channel 10070.

When exhausted nail bin 10000 from staple cartridge channel be removed after, further described above, new nail bin 10000 or any other suitable nail bin can be inserted into staple cartridge channel 10070.Further described above, nail bin is logical Road 10070, firing member 10052, and/or nail bin 10000 may include cooperative structures, and the cooperative structures can be in new non-percussion nail Storehouse 10000 prevents firing member 10052 again or is then pushed into towards distal side when being not located in staple cartridge channel 10070. More particularly, referring again to Figure 56, when firing member 10052, which is advanced to, to be contacted with sliding part 10050, and when slip When part 10050 is in its nearside non-firing position, the support nose 10055 of firing member 10052 can be positioned in sliding part On support lugn 10056 on 10050 and/or above so that firing member 10052 is maintained at position upward enough, with In preventing that the lock or crossbeam 10054 that extend from firing member 10052 from falling into the lock crossbeam being limited in staple cartridge channel.Due to lock 10054 when will not fall into lock crossbeam, in such situation, when firing member 10052 is pushed into, and lock 10054 can not abut lock The distal side side wall 10057 of groove.When firing member 10052 promotes sliding part 10050 towards distal side, firing member 10052 can Its upward firing position is supported on due to leaning against the support nose 10055 on support lugn 10056.Work as firing member 10052 relative to sliding part 10050 when bouncing back, as described above and as shown in figure 59, is being slided when support nose 10055 is not relyed on When on the support lugn 10056 of part 10050, firing member 10052 can fall from its upward position.For example, surgical staples may include Firing member 10052 can be biased to the spring 10058 and/or any other suitable biasing element of its down position.One Denier firing member 10052 has been fully retracted, as shown in figure 60, and firing member 10052 can not again pass through the nail bin 10000 used up It is pushed into towards distal side.More particularly, when the sliding part 10050 for being now in operation order has been left on the remote of nail bin 10000 When at side end 10002, firing member 10052 can not be maintained at its upper position by sliding part 10050.Therefore, as described above, If firing member 10052 is re-advanced in the case of no replacement nail bin, lock beams 10054 will contact lock crossbeam Side wall 10057, this will prevent firing member 10052 to be advanced to again towards distal side in nail bin 10000.In other words, once with Most nail bin 10000 is replaced by new nail bin, and new nail bin is by with proximally-oriented sliding part 10050, and this is proximally-oriented Sliding part firing member 10052 can be maintained to its upward position, and firing member 10052 is pushed away again towards distal side Enter.

As described above, sliding part 10050 can be by staple drivers 10040 in the first non-firing position and the second firing position Between move, so as to will nail 10030 from support section 10010 project.It is shot up from support section 10010 in nail 10030 After, staple drivers 10040 can be accommodated in nail cavity 10012.Support section 10010 may include that staple drivers can be prevented The 10040 one or more holding feature structures for projecting or dropping out from nail cavity 10012.Alternatively, sliding part 10050 can project staple drivers 10040 from the support section 10010 with nail 10030.For example, staple drivers 10040 It can be made up of for example bioabsorbable and/or biocompatible materials, such as PEI (Ultem).Staple drivers can It is attached to nail 10030.For example, staple drivers can be molded into above the base portion of each nail 10030 and/or surrounding so that driving Device is integrally formed with nail.Entitled " the SURGICAL STAPLES HAVING COMPRESSIBLE that September in 2006 is submitted on the 29th OR CRUSHABLE MEMBERS FOR SECURING TISSUE THEREIN AND STAPLING INSTRUMENTS FOR DEPLOYING THE SAME " U.S. Patent Application Serial Numbers 11/541,123 are incorporated by reference in its entirety herein.

As described above, surgery suturing appliance may include that the staple cartridge channel of nail bin can be received, be rotationally coupled to nail bin The anvil block of passage and the firing member including blade, the firing member can be moved relative to anvil block and staple cartridge channel.Using In, nail bin can be positioned in staple cartridge channel, and after nail bin is consumed at least in part, nail bin can be removed from staple cartridge channel And replaced by new nail bin.For example, the staple cartridge channel of surgery suturing appliance, anvil block, and/or firing member can be with replacing nail bin one Rise and be reused.Alternatively, nail bin may include a part for disposable loading unit component, and this disposably adds Carrier unit component for example may include staple cartridge channel, anvil block, and/or firing member, and these can be used as replacement disposable loading unit A part for component is replaced with nail bin.Some disposable loading unit components are disclosed in what is submitted within 2 15th, 2008 Entitled " END EFFECTOR COUPLING ARRANGEMENTS FOR A SURGICAL CUTTING AND STAPLING In INSTRUMENT " U.S. Patent Application Serial Number 12/031,817, the complete disclosure of the patent application is with the side of reference Formula is incorporated herein.

Tissue thickness compensation part may include composition that is extrudable, can casting and/or can be molded, and it includes as described herein At least one of synthetic material and/or non-synthetic materials.Tissue thickness compensation part may include the film with two layers or more layer Or piece.Tissue thickness compensation part can be used conventional method obtain, for example mix, be blended, combination, spraying, wicking, solvent evaporation, Dipping, brushing, gaseous phase deposition, extrusion, calendering, casting, molding etc..During extrusion, opening can include at least one opening The form of die head is that the extrudate exposed assigns shape.During calendering, opening may include the roll gap between two rollers.Conventional molding Method may include but be not limited to be blow molded, be molded, foam injection, compression moulding, hot forming, extrusion, foaming extrusion, film blowing, calendering, Spinning, solvent welding, coating method such as dip-coating and spin coating, solution curtain coating and film casting, plastisol processing (including scraper Coating, roller coat and casting), and combinations thereof.During injection, opening may include nozzle and/or passage/runner and/or mould Cavity and feature structure.During compression moulding, composition can be positioned in cavity body of mould, be heated to suitable temperature, and by relative Compressed and shaped under high pressure.During casting, composition can include liquid or slurries, and it, which injects or in other words provided, arrives mould Or the inside, the above and/or surrounding of object, with the feature structure of copy mold or object.After casting, composition can by drying, Cool down and/or be cured to form solid.

According to the present invention, manufacture includes at least one tissue thickness compensation part for preserving and/or being absorbed in medicine therein Method offer tissue thickness compensation part can be provided, and tissue thickness compensation part and medicament contact is retained medicine In tissue thickness compensation part.Manufacture include antiseptic materials microstructure thickness compensation part method may include offer hydrogel, Dried hydrogel, in silver nitrate aqueous solution swollen hydrogel, contact hydrogel and sodium chloride solution, there is antibacterial to be formed The tissue thickness compensation part of characteristic.Tissue thickness compensation part can include the silver being dispersed therein.

Referring now to Figure 71, tissue thickness compensation part 21020 may include compensating part main body 21022 and be positioned at therein many Individual capsule or pipe 21024.Each in pipe 21024 may include to be defined in cavity 21026 therein, and the cavity can be at it Include one or more medicines.As described in more detail below, tissue thickness compensation part 21020 can be manufactured in the following way： Pipe 21024 is placed in such as mould, and the formation compensating part main body 21022 around pipe 21024.Put by pipe 21024 One or more medicines can be placed on before putting in a mold in pipe 21024 so that solidify in compensating part main body 21022, freeze After dry and/or solidification, for example, pipe 21024 can be encapsulated in compensating part main body 21022.Alternatively, now Referring to Figure 72, tissue thickness compensation part 21120 may include to be positioned at multiple capsules or pipe in compensating part main body 21122 21124, wherein one or more medicines are loaded into pipe after being formed in compensating part main body 21122 around pipe 21124 In 21124.For example, tissue thickness compensation part 21120 may include port 21123, the port can be in fluid communication simultaneously with pipe 21124 And can allow for using such as syringe 21125 by one or more infusion of medicine into pipe 21124.In some cases, outside Medicine just can be loaded into pipe by section doctor or clinician before tissue thickness compensation part 21120 is inserted into the patient In 21124.There is the longer storage duration or during storage life when tissue thickness compensation part 21120 can be desired or needed for, this It can be particularly useful a bit.

Referring now to Figure 73, the compensating part main body 21022 of tissue thickness compensation part 21020 can be by for example bioabsorbable Material is constituted.Compensating part main body 21022 can be made up of any suitable material such as PGA and/or PCL.Pipe 21024 can be by for example Any suitable bioabsorbable material is constituted.Pipe 21024 can be by any suitable material such as hyaluronic acid, gelatin, PDS And/or oxidized regenerated cellulose (ORC) is constituted.One or more medicines 21025 in cavity 21026 may include stream Body, such as fortimicin.For example, each pipe 21024 can be sealed so that medicine 21025 can be stored in pipe 21024 until example Such as at least a portion of pipe 21024 has been dissolved and/or bio-absorbable.In use, referring now to Figure 74, pipe 21024 can be sudden and violent It is exposed to the body fluid that can contact and dissolve pipe 21024, such as blood.Referring to Figure 75, when tissue T and tissue thickness compensation part 21020 by such as anvil block 21060 and/or it is multiple nail 21030 compress when, body fluid can be squeezed out from tissue T., can according to the present invention Surrounded using bioabsorbable wrappage or at least partly around compensating part main body 21022.For example, wrappage can be by for example Hyaluronic acid and/or ORC are constituted.

Referring now to Figure 77, capsule or pipe 21224 may include such as multiple layers 21224a-21224d.Each pipe 21224 It may include such as outer layer or first layer 21224a, second layer 21224b, third layer 21224c and internal layer 21224d.Outer layer 21224a It can be made up of hemostatic material such as fibrin ferment.Second layer 21224b can be mould by antimicrobial and/or antibiotic materials such as strength Element and/or gentamicin are constituted.Third layer 21224c can be by anti-inflammatory material such as Diclofenac and/or NSAIDs structure Into.Internal layer 21224d can be made up of Healing material such as powder collagen synthetic material.Referring again to Figure 77, pipe 21224 can Be constructed and arranged to so that second layer 21224b be dissolved or at least partly be dissolved before outer layer 21224a be dissolved or At least substantially it is dissolved.Referring to Figure 76, outer layer 21224a mono- can start dissolving exposed to body fluid.When this moment is indicated as Between t0.Outer layer 21224a can be completely dissolved in several minutes, the process of a few hours and/or a couple of days, wherein constituting outer layer 21224a material can reach maximum effectiveness or concentration at the time of time t1 is designated as.At certain subsequent moment, until by when Between t2 at the time of indicate, outer layer 21224a can be dissolved completely or at least substantially.

As outer layer 21224a is dissolved, body fluid reaches second layer 21224b and starts to dissolve the second layer at least in part 21224b.Similar as above, second layer 21224b can be completely dissolved in several minutes, the process of a few hours and/or a couple of days, its The middle material for constituting second layer 21224b can reach maximum effectiveness or concentration at the time of time t3 is designated as.In various situations In, body fluid can reach second layer 21224b by outer layer 21224a so that outer layer 21224a and second layer 21224b can start together When or at least substantially simultaneously dissolve.In any situation, reader will note that reaching it most to the material for constituting outer layer 21224a The time t1 of big effect or concentration can occur before a time t 3.At certain subsequent moment, until at the time of instruction by time t5, Second layer 21224b can be dissolved completely or at least substantially.Such as reader it is also noted that, the time, t5 can be after the time t 2 Occur.As second layer 21224b is dissolved, body fluid reaches third layer 21224c and starts to dissolve third layer at least in part 21224c.Similar as above, third layer 21224c can be completely dissolved in several minutes, the process of a few hours and/or a couple of days, its The middle material for constituting third layer 21224c can reach maximum effectiveness or concentration at the time of time t6 is designated as.In various situations In, body fluid can reach third layer 21224c by outer layer 21224a and second layer 21224b so that outer layer 21224a, the second layer 21224b and/or third layer 21224c can start simultaneously or at least substantially to dissolve simultaneously.In any situation, reader will note that Reach that the time t3 of its maximum effectiveness or concentration can occur before time t 6 to the material for constituting second layer 21224b.Subsequent Certain moment, until at the time of instruction by time t8, third layer 21224c can be dissolved completely or at least substantially.Such as reader It should be noted that, time t8 can occur after time t 5.

As third layer 21224c is dissolved, at the time of being indicated by time t4, body fluid reaches the 4th layer of 21224d simultaneously Start to dissolve the 4th layer of 21224d at least in part.It is similar as above, the 4th layer of 21224b can several minutes, a few hours and/or It is completely dissolved in the process of a couple of days, wherein constituting the 4th layer of 21224d material can reach most at the time of time t7 is designated as Big effect or concentration.In various scenarios, body fluid can be reached by outer layer 21224a, second layer 21224b and third layer 21224c 4th layer of 21224d so that outer layer 21224a, second layer 21224b, third layer 21224c and/or the 4th layer of 21224d can start At least substantially dissolve simultaneously or simultaneously.In any situation, reader will note that being reached to the material for constituting third layer 21224c The time t6 of its maximum effectiveness or concentration can occur before time t7.At certain subsequent moment, until indicated by time t9 Moment, the 4th layer of 21224d can be dissolved completely or at least substantially.Such as reader it is also noted that, time t9 can be in time t8 Occur afterwards.Optionally, as above-mentioned result, can occur the release stage by stage of medicine.

Referring now to Figure 81 and 83, nail bin 21300 may include warehouse 21310, and the warehouse is therein more including being positioned at Individual nail cavity 21312 and multiple nails 21330.Nail bin 21300 may also include tissue thickness compensation part 21320, and the tissue thickness is mended Repay part may include can against warehouse 21310 position compensating part main body 21322 and be positioned in addition in compensating part main body 21322 Multiple discrete capsules 21324.Capsule 21324 can be vertically oriented, and when nail 21330 is in its non-percussion configuration When, as shown in Figure 83, each capsule 21324 can be positioned between the nail leg 21322 of nail 21330.For example, when nail 21330 In its non-firing position without making during the rupture of capsule 21324, nail leg 21322 can extend at least partly into tissue thickness's benefit Repay in part 21320.When nail 21330 moves to its firing position from its non-firing position, referring now to Figure 84, nail 21330 can The rupture of capsule 21324 is set to discharge at least one medicine wherein stored.More particularly, when nail 21330 is lifted upwards When rising, nail 21330 can be deformed by the forming pit 21062 being defined in anvil block 21060 so that nail leg 21332 can be towards positioning Capsule 21324 therebetween is downwardly and inwardly crimped or deformed.Nail 21330 can be lifted up by trigger system, the percussion System includes driver 21340 and sliding part 21345, and wherein sliding part 21345 can longitudinally traverse nail bin 21000 and order Lift the staple drivers 21340 and nail 21330 of positioning thereon in ground.In any situation, nail leg 21332 is pierceable and/or presses Routed capsule 21324 so that the internal cavity 21326 being defined in capsule 21324 can be destroyed and be contained in inner chamber One or more medicines in body 21326 can therefrom escape.One or more medicines may include for example contained therein One or more powder and/or fluid.Nail bin 21300 may also include cutting element 21380, and the cutting element can be with slip Part 21345 is promoted with the crosscutting tissue T being for example positioned between nail bin 21300 and anvil block 21060 towards distal side together.Cutting element 21380 can be by the cutter slit 21314 that is defined in warehouse 21310, wherein for example one or more capsule such as capsules Agent 21324 can be positioned within cutter slit 21314 and/or on so that cutting element 21380 can crosscutting such capsule 21324.In any situation, tissue thickness compensation part 21320 may also include the top and/or bottom for being positioned at warehouse 21322 On layer 21321, such as described layer can be made up of such as hyaluronic acid, and can stablize warehouse 21322 and/or nail 21330.Example Such as, when cutting element 21380 is advanced through nail bin 21300 as described above, cutting element 21380 being capable of crosscutting layer 21321。

Referring now to Figure 85, tissue thickness compensation part 21420 may include compensating part main body 21422 and be positioned at therein many Individual capsule 21444.Similar as above, each capsule 21444 may include sealed cavity 21446, and the cavity can be Wherein releasedly store one or more medicines.Each capsule 21444 may include such as circular cone and/or tapered distal end 21447.For example, capsule 21444 is held in place by using tapered distal end 21447, while being formed around warehouse 21422.According to the present invention, mould may include multiple holes and/or the indenture that can receive and fix tapered distal end 21447 so that When compensating part material is poured into around capsule 21444, capsule 21444 can be held in place by by mould.To upper Text is described further, capsule 21444 can be positioned and be arranged so that followed closely during use by percussion enter and/ Or through tissue thickness compensation part 21420, they just can be destroyed or rupture.

Alternatively, referring now to Figure 86, tissue thickness compensation part 21520 may include to be positioned at compensating part master Multiple capsules 21524 in body 21522.Capsule 21524 can each include being defined in one or more of its outer wall hole 21528, its mesopore 21528 can allow for one or more medicines 21525 from the cavity 21526 being defined in capsule 21524 Escape.The size of hole 21528 can be configured to and can control the speed that medicine 21525 is escaped from cavity 21526.For example, larger Hole 21528 can allow the comparatively fast release of medicine 21525, and for example, less hole 21528 can allow medicine 21525 compared with On The Drug Release. The outer wall of each capsule 21524 can be made up of the pipe with closed and/or sealed end 21527.Outside capsule 21524 Wall can be made up of for example one or more bioabsorbable polymer, and end 21527 is using such as hot melting process, heat Welding procedure and/or laser welding process it is closed and/or sealing.The outer wall or housing of capsule 21524 can utilize molding process Manufacture, wherein after housing is formed, can be positioned one or more medicines in the housing by one or more openend. Then, one or more of housing openend is covered using such as polymer solution.Capsule 21524 wall by that can give birth to In the case that the material that thing absorbs is constituted, being defined in hole 21528 therein can increase over time.For example, medicine 21525 The speed discharged from cavity 21526 can increase over time.

Compensating part main body 21522 can be made up of such as gelatin, and be manufactured into foamed material using such as lyophilized technique. Capsule 21524 can be inserted in compensating part main body 21522, wherein for example, compensating part main body 21522 can be formed with to receive The hole of capsule 21524.For example, layer or film can be then placed on to compensating part main body 21522 above to cover or around wherein Capsule 21524.Capsule 21524 can be positioned in mould and compensating part material can be made at least partly around capsule Agent 21524 shapes to form compensating part main body 21522.In any situation, compensating part main body 21552 may include one or more Keying or indexing structure, one or more of keyings or indexing structure can make tissue thickness compensation part 21520 and nail bin Warehouse is aligned and oriented so that capsule 21524 is positioned with required position.

Referring now to Figure 87, surgical stapling system may include nail bin 21600 and anvil block 21060, wherein nail bin 21600 and anvil Seat 21060 can be positioned on the opposite side of tissue T.Similar with other nail bins disclosed herein, nail bin 21600 may include warehouse 21310, the warehouse includes the multiple nail cavities 21312 being positioned in and multiple nails 21330.In use, referring to Figure 91, nail 21330 can be lifted up firing position by the never firing position of driver 21340 so that they become against anvil block 21060 Shape, or more particularly, deformed in forming pit 21062.As nail 21330 is fired, structure is not fired at it in nail 21330 Before being deformed between type (Figure 88) and its percussion configuration (Figure 89), nail 21330 can pierce tissue T and be attached to anvil block 21060 Tissue thickness compensation part 21620.Nail 21330 can be made up of any suitable material such as stainless steel and/or titanium, and can Apply compression or clamping force against tissue thickness compensation part 21620 and tissue T.As shown in Figure 87, nail 21330 can be with multiple row cloth Put, one of nail 21330 can be positioned in each nail cavity 21312.Nail bin 21300 may also include the (figure of puncture member 21635 90), the puncture member can engage and pierce through such as tissue T, tissue thickness compensation part 21620 and/or be positioned at tissue thickness The one or more medicine capsules spent in compensating part 21620.For example, puncture member 21635 can be positioned in nail cavity 21312, Wherein puncture member 21635 from nail cavity 21312 can be fired or projected by driver 21340.Further described above, Some nail cavities 21312 of nail bin 21600 may include to be positioned at nail 21330 therein, and other nail cavities 21312 may include to be positioned at Puncture member 21635 therein.Nail bin 21600 may include some only with the nail cavity 21312 for being positioned at nail 21330 therein Row, only have be positioned at puncture member 21635 therein some rows, and/or be positioned at it is therein nail 21330 and puncture Both some rows of component 21635.As illustrated, referring to Figure 91, the row of inside four of nail cavity 21312 can only include nail therein 21330, and the outer row of nail cavity 21312 may include both nail 21330 therein and puncture member 21635.Outside nail cavity 21312 Nail 21330 and puncture member 21635 in portion's row can for example be alternately arranged mode and arrange.Referring now to Figure 92,21330 Hes are followed closely Puncture member 21635 can include two nails 21330, be puncture member 21635 afterwards, the nail 21330 that to be afterwards two other, Be afterwards puncture member 21635, the like mode arrangement.

Referring primarily to Figure 90, each puncture member 21635 may include base portion 21638 and the opposite side from base portion 21638 The leg 21637 upwardly extended.Referring now to Figure 91, driver 21340 can each include groove 21348, and the groove can be received simultaneously Support the base portion 21638 of puncture member 21635.When pushing up driver 21340 by sliding part 21345, referring now to Figure 92, sliding part 21345 can sequentially percussion nail 21330 and puncture member 21635.Referring now to Figure 91, nail 21330 can be against Anvil block 21060 is deformed, and puncture member 21635 can not contact anvil block 21060.Referring primarily to Figure 90, each puncture member 21635 One or both of leg 21636 may include for example sharp top 21639 and at least one barb 21637, the sharp top End can pierce through tissue T and/or tissue thickness compensation part 21620, and leg 21636 can be maintained at group by least one described barb Knit in T and/or tissue thickness compensation part 21620.Tissue thickness compensation part can not be used.The leg of puncture member 21635 21636 can be insufficient to length, it is impossible to all the way through tissue T, let alone contact anvil block 21060.Leg 21636 can long enough so that They can contact anvil blocks 21060 and may be deformed to various configuration.

Puncture member 21635 can be made up of the material of the material different from constituting nail 21330.Puncture member 21635 can be by At least one bioabsorbable polymer such as PGA is constituted.Puncture member 21635 can each self-contained at least one medicine, it is all Such as antiseptic, antiinflammatory, anodyne and/or MMP inhibitor.When puncture member 21635 can be positioned in staple line, for example, with Puncture member 21635 to be dissolved and/or by bio-absorbable, one or more medicines can be supplied to nail by puncture member 21635 Within line and/or neighbouring tissue T.Puncture member 21635 can be coated with one or more medicines.Puncture member 21635 can be wrapped Containing the one or more medicines being embedded in the structural substrates for constituting puncture member 21635.For example, some puncture members 21635 It can be made up of first structure substrate and/or the first medicine, and other puncture members 21635 can be by second or different structure substrate And/or second or different pharmaceutical composition.Puncture member 21635 is manufactured using such as molding process.

Referring now to Figure 93 and 94, nail bin 21700 may include warehouse 21710 and be positioned at the platform table of warehouse 21710 Tissue thickness compensation part 21720 on or near face 21711.Similar as above, warehouse 21710 may include to be positioned at therein many Individual nail cavity 21312 and multiple nails.Warehouse 21710 may also comprise slit 21714, and the slit can receive cutting structure wherein Part, such as cutting element 21380 (Figure 95).In use, as shown in Figure 95, cutting element 21380 crosscutting can be positioned at anvil Tissue T between seat 21060 and nail bin 21700.Referring again to Figure 93 and 94, tissue thickness compensation part 21720 may include compensation Part main body 21722 and multiple medicine packages or the capsule 21724 being positioned in compensating part main body 21722.Capsule 21724 Can be positioned and be arranged in compensating part main body 21722 so that capsule 21724 be covered in be defined in it is narrow in warehouse 21710 On groove 21714.In use, referring primarily to Figure 96, when cutting element 21380 is advanced through nail bin 21700, cutting element 21380 can cut capsule 21724.For example, can cut component 21380 cutting before fluid sealant wafer 21724, and After cutting capsule 21724, the one or more medicines being contained therein can be released.Due to capsule 21724 Position on slit 21714, the cut component 21380 that one or more medicines releasably arrive tissue T is crosscutting On part.The one or more medicines being contained in capsule 21724 may include the biological agent of such as powder type.Capsule One or more medicines in agent 21724 can include such as oxidized regenerated cellulose, alginates and/or calcium.

Referring again to Figure 93 and 94, capsule 21724 can include identical medicine wherein.Alternatively, One or more of capsule 21724 can be wherein comprising one or more different medicines.More than first capsule 21724 The first medicine can be included wherein, and more than second capsule 21724 can include the second medicine wherein.For example, capsule 21724 can be arranged along the longitudinal path of cutting element 21380 with being alternately arranged mode, for example, cause the glue for including the first medicine Can be the capsule 21724 comprising the second medicine after wafer 21724, and after the capsule 21724 comprising the second medicine Can be the capsule 21724 comprising the first medicine, for example the like.When cutting element 21380 is advanced through nail bin 21300 When, cutting element 21380 can mix the first medicine with the second medicine.Referring again to Figure 93 and 94, tissue thickness Compensating part 21720 may also include the one or more passages 21726 stretched out from each capsule 21724.In cut-out capsule After agent 21724, passage 21726 can allow for medicine in capsule 21724 tissue thickness compensation part 21720 and against its Migrated in the tissue T of positioning.Capsule 21724 enable to when by anvil block 21060 to its apply compressive load when they not It can rupture.Referring primarily to Figure 93 and 96, warehouse 21710 may include multiple grooves 21715, and the multiple groove each can be at it Middle at least a portion for receiving capsule 21724.For example, when applying compressive load to capsule 21724, the energy of groove 21715 Enough allow the slide downward in groove 21715 of capsule 21724 so that capsule 21724 can not rupture.Alternatively select Select, only when meeting or exceeding the specific compression power being applied thereto, one or more of capsule 21724 can be broken Split.For example, capsule 21724 can bear the clamping pressure that anvil block 21060 is applied, but when due to such as cutting element 21380 is rupturable when being just advanced through nail bin 21700 and increasing the compression pressure being applied thereto.Capsule 21724 can be Lubricant is wherein included, when cutting element 21380 is promoted and/or bounced back in nail bin 21700, the lubricant can be conducive to The motion of cutting element 21380.

Referring now to Figure 97, tissue thickness compensation part 21820 may include compensating part main body 21822 and extend through wherein Longitudinal pipe 21824.Similar as above, pipe 21824 may include to be defined in longitudinal cavity 21826 therein and be positioned at cavity One or more medicines 21825 in 21826.Longitudinal pipe 21824 may also include the one or more supports stretched out from it Leg 21827, one or more of supporting legs being capable of support tube 21824.For example, referring now to Figure 98, supporting leg 21827 can be propped up Pipe 21824 in hold mode tool 21890, and compensating part main body 21822 is formed around pipe 21824., can referring now to Figure 99 and 100 The material such as PGA and/or PCL that constitute compensating part main body 21822 are poured into around pipe 21824, be then allowed to for example to freeze, Foaming and/or solidification.Referring again to Figure 98, the material for constituting compensating part main body 21822 can be poured into the chamber around pipe 21824 In body 21891, wherein cavity 21891 can be closed then by lid 21892.Referring to Figure 97, the end of supporting leg 21827 can not be by The material poured into is covered and can flushed with the lower surface 21821 of compensating part main body 21822.Supporting leg 21827 and/or pipe 21824 can be by can dissolve and/or bioabsorbable material such as gelatin, hyaluronic acid, PDS and/or ORC are constituted.Leg 21827 Can quickly be dissolved by such as body fluid and/or saline solution, wherein can leave the neighboring of tissue thickness compensation part 21820 with it is interior The passage or path extended between portion.Such path can be formed to allow to be positioned at one or more medicines in pipe 21824 21825 are quickly dissolved and/or are absorbed.Alternatively, tissue thickness compensation part 21920 for example may include compensating part Main body 21922 and the pipe 21924 with multiple supporting legs 21927, as shown in Figure 101.Referring to Figure 102, supporting leg 21927 can To can extend across the larger supporting network of compensating part main body 21922 or a part for structural lattice 21928.

Referring again to Figure 97, the leg 21827 extended from pipe 21824 also can be wherein comprising one or more medicines.Work as leg 21827 when being dissolved and/or absorb as described above, one or more medicines in leg 21827 can to suture and/or The tissue of cutting provides the first medicine response, and one or more medicines 21825 in pipe 21824 can provide second or with Medicine response afterwards.Referring now to Figure 103 and 105, tissue thickness compensation part 22020 may include compensating part main body 22022 and Extend through longitudinal medication tube 22024 of compensating part main body 22022.Similar as above, pipe 22024, which can limit to include, is positioned at it In one or more medicine 22025a longitudinal cavity 22026a.Also similar as above, pipe 22024 may include can be along pipe Multiple longitudinal leg support members 22027 of 22024 length extension.Optionally, each leg support member 22027 can limit vertical wherein To cavity, such as cavity 22026b and 22026c, the cavity can be each wherein comprising one or more medicines, such as medicine 22025b and 22025c.Leg support member 22027 can make it that medicine 22025b and 22025c can by that quickly can be dissolved and/or absorbed The material being fast released is constituted.Then, supporting leg 22027 and pipe 22024 further can be dissolved and/or be absorbed so that medicine Thing 22025a can be subsequently released.Medicine 22025a, 22025b and/or 22025c can be constructed from the same material.It is used as other one Selection is planted, medicine 22025a, 22025b and/or 22025c can be made up of different materials.Medicine 22025b and 22025c can be by phases Same one or more materials are constituted, and one or more materials may differ from constituting medicine 22025a one or more materials Material.

Further described above, pipe 22024, leg 22027 and/or being defined in cavity 22026a- therein 22026c can utilize molding process manufacture.Pipe 22024, leg 22027 and/or cavity 22026a-22026c are available for example to be extruded Technique is manufactured, wherein as a result, this class formation may include the continuous cross section along its length.It is used as the knot of such technique Really, pipe 22024 and leg 22027 may be integrally formed.Then, medicine 22025a-22025c can be respectively positioned in cavity 22026a- In 22026c.Medicine 22025a-22025c can for example one or more powder of each freedom and/or one or more fluid compositions. Referring now to Figure 106, salable cavity 22026a-22026c end 22029 is so as to wherein comprising medicine 22025a- 22025c.In any situation, then pipe 22024 can be positioned in all such as above-mentioned moulds 21890 of mould, wherein will can constitute The material of compensating part main body 22022 is poured into around pipe 22024, as shown in Figure 104, to form tissue thickness compensation part 22020. Various alternative forms are shown in Figure 107 and 108.Referring to Figure 107, tissue thickness compensation part 22120 may include compensating part main body 22122 and multiple longitudinal pipes 22124 for linking together.Each pipe 22124 can limit longitudinal cavity 22126, institute wherein Stating longitudinal cavity can be each wherein comprising one or more medicine 22125.Longitudinal cavity 22126 can not be in fluid communication each other, Or one or more longitudinal cavities 22126 can be in fluid communication with each other.Similar as above, compensating part 22120 may also include from pipe 22124 legs 22127 extended downwardly, and can each include longitudinal cavity 22126 and at least one medicine 22125 therein. Pipe 22124 and/or supporting leg 22127 can be by that can be constituted with the material of different rates dissolving and/or bio-absorbable.For example, branch Support leg 22127 can be by for example can be than constituting the dissolving of material faster speed and/or the material structure of bio-absorbable of pipe 22124 Into.Referring now to Figure 108, tissue thickness compensation part 22220 may include compensating part main body 22222 and longitudinal pipe 22224, wherein managing 22224 may include multiple supporting legs 22227 from its extension.Single longitudinal cavity 22226 can be defined in pipe 22224 and can Extend in supporting leg 22227.Similar as above, cavity 22226 can include and be positioned at one or more medicines therein 22225。

Referring again to Figure 97, supporting leg 21827 can by can absorb fluid such as blood and/or saline solution one kind or Multiple material is constituted.Supporting leg 21827 can make fluid towards pipe 21824 and the core of one or more medicines 21825 contained therein Inhale.Such wicking can allow medicine 21825 in agglutination early stage dissolving and/or bio-absorbable.The end of supporting leg 21827 can Do not covered by compensating part main body 21822 and fluid can be exposed to.For example, the wicking process can occur by capillarity, And can occur in the case where not considering the orientation of tissue thickness compensation part 21820.

Referring now to Figure 112, tissue thickness compensation part 22320 may include compensating part main body 22322 and be positioned at therein Multiple pipes 22324.Compensating part main body 23222 can be by reproducibility organization bracket foam such as acellular nethike embrane bio-matrix, nethike embrane Timbering material and/or ACell are constituted.Nethike embrane timbering material may include the hydrophilic foam as made from Skeleton nethike embrane, and Can be compressible in certain situation.When exposed to a fluid, nethike embrane timbering material is expansible and to the group positioned against it Knit application pressure.ACell is to provide the extracellular matrix or the reproducibility product of support network for promoting cell propagation and migration.Structure Organization bracket into compensating part main body 22322 can be loaded with such as stem cell, PRP or growth factor.Constitute compensating part main body 22322 organization bracket can be coated with such as collagen stroma.The tissue scaffolding matrix of compensating part main body 22322 can be by fiber base Texture is into and fibre substrate can be made up of the fiber of random orientation.In some cases, it is made up of the fiber of random orientation Fibre substrate can not provide required elasticity or resilience in compensating part main body 22322.In consideration of it, random orientation Fiber can be made up of and/or can be coated with hydrophilic material hydrophilic material, the hydrophilic material exposed to liquid it Afterwards, the compression stress needed for can extending and being provided to the elasticity needed for fibre substrate offer and/or to tissue.In various situations In, fibre substrate can be not exposed to liquid, after fibre substrate is by multiple clench by tissue capture, as described above.For example, Compensating part main body 22322 may include the impermeable wrappage of liquid, in use, and the wrappage can for example be destroyed, pierced Wear, cut and/or tear, to allow liquid to enter compensating part main body 22322 and close to hydrophilic fibre.In any situation, When the backing substrate that liquid is trapped in nail absorbs, backing substrate is expansible to be pressed with applying to the tissue being also trapped in nail Compression pressure, and elapse over time, the tissue adapted in backing substrate is grown into.

Further described above, the pipe 22324 of tissue thickness compensation part 22320 can be by that can dissolve and/or give birth to The degradation material that thing absorbs is constituted.Similar as above, each pipe 22324 may include wherein to include one or more medicines Internal cavity and another or multiple supporting legs 22327 are sealed, one or more of supporting legs can degrade and provide The passage or flow path of liquid are to reach the medicine of storage in pipe 22324.Such degraded of supporting leg 22327 can need necessarily Time, therefore the medicine being contained in pipe 22324 can not discharge immediately.In some sense, fluid degradation leg 22327 can need Certain period of time, wherein therefore, leg 22327 may act as being designed to the fuse of the release of medicine in phantastron 22324.So as to, In various scenarios, the leg 22327 with long length and/or thicker cross section can provide longer delay, and with shorter The leg 22327 of length and/or relatively thin cross section can provide shorter delay.Pipe 22324 can be by quick and/or slow mechanism dissolved material Material is constituted；However, in either case, the degraded of pipe 22324 can all occur in certain period of time, so as to postpone to be contained in The release of one or more medicines in pipe 22324.According to the present invention, the first pipe 22324 can be by with the of first rate degradation One material is constituted, and the second pipe 22324 can be made up of the second material with second or different rates degraded.In such situation In, the first medicine being contained in the first pipe 22324 can be released for example before the second medicine being contained in the second pipe 22324 Put.For example, the first pipe 22324 can have the outer wall thinner than the second pipe 22324, this can allow the first pipe 22324 to the second to manage 22324 faster degrade, and allow to discharge before medicine of the medicine being contained in the first pipe 22334 in the second pipe 22324.Make For above-mentioned result, for example, the first pipe 22324 can discharge the first medicine in first time point, the second pipe 22324 can be the Two or subsequent time points discharged the second medicine, and the 3rd pipe 22324 can discharge the 3rd medicine at the 3rd or rear time point.

Referring now to Figure 113 and 114, tissue thickness compensation part 22420 may include compensating part main body 22422 and be positioned at Sealing container 22424 in compensating part main body 22422.It is similar as above, container 22424 can limit longitudinal cavity 22426 and The one or more medicines 22425 being positioned in longitudinal cavity 22426.Container 22424 can be flexible so that when compression or pressure During flat tissue thickness compensation part 22420, as shown in Figure 114, container 22424 can attempt to resilience or keep its initial not deformed shape Shape.For example, container 22424 may include the spring member being positioned in compensating part main body 22422.Container 22424 can not broken Change shape in the case of splitting.For example, container 22424 can degrade when exposed to liquid, such as it is as described herein.

Referring now to Figure 115, tissue thickness compensation part 22520 may include compensating part main body 22522 and multiple sealing containers 22524a-22524c.Each in container 22524a-22524c limits neighboring, and the neighboring can increase, maximize And/or optimization touches the surface area of the container of liquid such as blood and/or saline solution.In various scenarios, with larger The container of surface area can be exposed to larger amount of liquid, therefore speed can be dissolved and/or bio-absorbable faster.Accordingly Ground, the container with small surface area can be exposed to small amount of liquid, therefore speed that can be slower is dissolved and/or biological Absorb.Container 22524a-22524c can be made up of such as gelatin, hyaluronic acid, PDS and/or ORC.It is similar as above, container 22524a-22524c can be flexible and can provide screen resilience or elastic bias force.Referring now to Figure 116, tissue thickness is mended Repay multiple elastic component of thing that part 22620 may include compensating part main body 22622 and be positioned in compensating part main body 22622 22624.Each laminated component of thing 22624 may include sealing inner passage, and the sealing inner passage is therein comprising being positioned at One or more medicines.

Referring now to Figure 117, the end effector of surgery suturing appliance may include anvil block 21060 and nail bin 22700.Anvil block 21060 may include to be attached tissue thickness compensation part 22770 thereon, and nail bin 22700 may include warehouse 22710 and tissue Thickness compensation part 22720.Referring now to Figure 118, tissue thickness compensation part 22770 may include multiple layers, and wherein tissue thickness is mended To repay part 22720 may include first layer 22771 and the second layer 22772, but it is envisioned that alternative form, wherein tissue thickness compensation part can Including more than two layers.Optionally, one or more layers of tissue thickness compensation part may include weaving material.First layer 22771 can It is made up of multiple first silk threads 22773 and multiple second silk threads 22774, the multiple first silk thread is made up of the first material, institute Multiple second silk threads are stated to be made up of second or different materials.Similarly, the second layer 22772 can be by multiple Hes of first silk thread 22773 Multiple second silk threads 22774 are constituted.The concentration of first silk thread 22773 and the second silk thread 22774 in first layer 22771 can be with Concentration of one silk thread 22773 with the second silk thread 22774 in the second layer 22772 is identical.First silk thread 22773 and the second silk thread 22774 concentration in first layer 22771 can be dense in the second layer 22772 with the first silk thread 22773 and the second silk thread 22774 Degree is different, as described in more detail below.

Further described above, the first silk thread 22773 can by bioabsorbable polymer such as PGA, PDS, PCL and/or PLA is constituted, and the second silk thread 22774 can be made up of such as oxidized regenerated cellulose (ORC).First layer 22771 It may include the outer layer of tissue thickness compensation part 22770 and may include tissue contacting surface.First layer 22771 can be included than second More first silk threads 22773 of silk thread 22774.For example, first layer 22771 can include such as the about 80% the first silk threads 22773 With the ratio of the about 20% the second silk threads 22774.First layer 22771 can comprising such as the about 60% the first silk threads 22773 with it is big The ratio of the ratio of about 40% the second silk threads 22774, the about 67% the first silk threads 22773 and the about 33% the second silk threads 22774, The ratio of about 70% the first silk threads 22773 and the about 30% the second silk threads 22774, the about 75% the first silk threads 22773 with it is big The ratio of about 25% the second silk threads 22774, and/or the about 90% the first silk threads 22773 and the about 10% the second silk threads 22774 Ratio.

Further described above, the first silk thread 22773 can be by with slower than the material for being constituted the second silk thread 22774 Speed dissolving, bio-absorbable and/or change state material constitute.For example, the second silk thread 22774 can by for example exposed to Can be changed into during liquid from solid gel ORC silk threads constitute, and ORC silk threads can be reacted when for example exposed to blood platelet and from Solid is changed into gel.In such situation, however, first layer 22773 mainly can be made up of bioabsorbable polymer filaments, The polymer filaments can be more more slowly than ORC silk thread speed and liquid reactions, therefore, first layer 22773 can be in a variety of feelings Tissue or body fluid are touched under condition, without losing its global shape and structure.That is, the ORC fibers in first layer 22773 It can be reacted when touching liquid and/or tissue first；However, ORC gels can be maintained at least in part or mostly In first layer 22773.

The second layer 22772 may include the internal layer of tissue thickness compensation part 22770 and may not include directly tissue contact table Face.The second layer 22772 can be included than the first less silk thread 22773 of the second silk thread 22774.For example, the second layer 22772 can be included The ratio of such as the about 20% the first silk threads 22773 and the about 80% the second silk threads 22774.The second layer 22772 can be comprising for example The ratio of about 40% the first silk threads 22773 and the about 60% the second silk threads 22774, the about 33% the first silk threads 22773 with it is big The ratio of the ratio of about 67% the second silk threads 22774, the about 30% the first silk threads 22773 and the about 70% the second silk threads 22774, The ratio of about 25% the first silk threads 22773 and the about 75% the second silk threads 22774, and/or the about 10% the first silk threads 22773 With the ratio of the about 90% the second silk threads 22774.

Further described above, the second layer 22772 can be included for example than bioabsorbable polymer filaments more Many ORC silk threads.The second layer 22772 can include ORC silk threads more more than first layer 22771.Because the second layer 22772 is not outer Layer, liquid can not contact the second layer 22772 immediately, because liquid must first pass through first layer before the contact second layer 22772 22771.In such cases, the second layer 22772 may include more highdensity ORC silk threads, because in the second protected layer 22772 ORC silk threads will not immediately become gel.Even if in the second layer 22772 ORC thread contacts are to liquid and are changed into gel, ORC Gel can be also contained in tissue thickness compensation part 22770 by first layer 22771, as described above, the first layer can be at least Its general shape is initially kept, and support mesh sheet is provided to the second layer 22772.Although using ORC fibers and biological can inhale The fiber of receipts, but optionally, other suitable materials can be utilized.

Further described above, referring now to Figure 121-123, tissue thickness compensation part 22770 can be positioned in Between anvil block 21060 and tissue T, wherein can be against tissue T compression organization thickness before the percussion nail 21330 of nail bin 22700 Compensating part 22770.In percussion nail 21330 with capture wherein tissue T and tissue thickness compensation part 22720 and 22770 it Afterwards, the warehouse 22710 of anvil block 21060 and nail bin 22700 can be away from compensating part 22720,22770 and tissue T motion and from hand Art position is removed.Referring now to Figure 119, the layer 22871 of tissue thickness compensation part can include weaving silk thread 22873, the weaving Silk thread may include for example elongated or flat cross section.Referring now to Figure 120, the layer 22971 of tissue thickness compensation part can be wrapped The silk thread 22973 containing weaving, the weaving silk thread may include such as circular cross section.

Various alternative forms are shown in Figure 124-127.Referring now to Figure 125, the end effector of surgery suturing appliance It may include the tissue thickness compensation part 22770 ' of anvil block 21060 and positioning thereon.Referring to Figure 124, tissue thickness compensation part 22270 ' may include layer 22771 ', and the layer can include many first fibers with many second fiber 22774 ' braidings 22773’.For example, the first fiber 22773 ' can be with than the faster speed dissolving of the second fiber 22774 ' and/or bio-absorbable. Gap, opening and/or pit can be defined between the first fiber 22773 ' and the second fiber 22773 ", so as to allow liquid flow Move through layer 22771 '.Referring now to Figure 127, the end effector of surgery suturing appliance may include to be attached to anvil block 21060 Tissue thickness compensation part 22770 ".Referring to Figure 126, tissue thickness compensation part 22770 " may include the weaving layer of silk thread 22771 ", The silk thread can be embedded in and/or be encapsulated in substrate 22772 ".Silk thread 22771 " can expose, and alternatively, Before the exposure of silk thread 22771 ", at least a portion of substrate 22772 " must may be dissolved and/or bio-absorbable.For example, structure Material into substrate 22772 " can be filled within any gap, opening or the pit being defined between silk thread 22771 ".

Referring now to Figure 132, nail bin 23000 may include tissue thickness compensation part 23020.It is as described herein, tissue thickness Compensating part is manufactured using such as lyophilized technique.Solution comprising such as PGA and/or PCL can be poured into mould, wherein For example in the presence of the temperature of vacuum atmosphere and/or reduction solution can be allowed to grow up to open celled foam.For example, PGA materials can be according to example Such as existed in solution for about 64/36 ratio of PLA material by weight.Referring to Figure 128, fiber and/or filament 23021 It can for example be mixed into solution.PGA fibers can be for example scattered in solution before being poured into mould so that PGA fibers can For example equably or at least substantially uniform it is distributed in whole tissue thickness compensation part 23020., can be by other situations PGA fibers are for example placed in solution and/or are placed directly within mould so that PGA fibers can for example towards mould bottom precipitation or Sedimentation.In other situations, PGA fibers can float on the top of solution.Solvent may be present in any situation, in solution all Such as dioxane, this can help to freeze-drying process.Dioxane can not be anti-with PGA fibers in solution Should or at least substantially it react.

Further described above, fiber 23021 can be before being mixed into solution and/or being mixed with solution with one Plant or multi-medicament coating.Referring to Figure 130, every fiber 23021 may include substrate 23022, and the substrate can be closed using any Suitable manufacturing process is coated with least in part with coating 23023.Referring to Figure 129, fiber 23021 can be manufactured using expressing technique, For example at least one medication coat is placed in PGA substrates in an extrusion process.For the medicine for the high temperature that can bear expressing technique For thing, these are particularly useful.Referring to Figure 131, using carrying object such as supercritical carbon dioxide, drug coated and/ Or dipping fiber 23021.In any situation, the fiber 23021 of painting medicine can be mixed with solution so that fiber 23021 In embedded tissue thickness compensation part 23020.In various scenarios, therefore, the coating of fiber 23021 can start to dissolve and discharge it In contained one or more medicines.Fiber 23021 closer to the outer periphery Positioning of tissue thickness compensation part 23020 can leaned on more First start dissolving before the fiber 23021 of the positioned internal of nearly tissue thickness compensation part 23020.In such situation, dissolving Fiber 23021 can leave multiple cavities or cavity network in tissue thickness compensation part 23020, wherein such cavity can allow group The cell or tissue knitted in thickness compensation part 23020 is grown into.Tissue thickness compensation part can include many first fibers, described many First fiber can than many second fibers quickly dissolve.For example, the first fiber may include PGA fibers, the PGA fibers example As passed through gamma-radiation.Optionally, for example, the PGA fibers through gamma-radiation are quickly molten than the PGA fibers without gamma-radiation Solution.

Optionally, one or more colouring agents can be added in above-mentioned solution so that organize thick as made from the solution Degree compensating part can have suitable color.May want to tissue thickness compensation part has and its surrounding environment formation sharp contrast Color.For example, tissue thickness compensation part may be, for example, green and/or blueness.

Referring now to Figure 133 and 135, tissue thickness compensation part 23120 may include compensating part main body 23122 and be distributed in Multiple drug particles 23121 in whole compensating part main body 23122.Compensating part main body 23122 can be made up of hydrophobic material.Example Such as, compensating part main body 23122 can be made up of such as material including PCL/PGA, and wherein PCL and PGA can be according to by weight 65/35 ratio is present in material.Referring now to Figure 134, drug particle 23121 can be all comprising one or more medicines 23123 Such as fortimicin, percarbonate and/or ascorbic acid phosphoric acid esters, one or more medicines can be by by such as hydrophily material Expect that the shell or housing 23124 that constitute encapsulate and/or are incorporated in the shell being made up of such as hydrophilic material or housing 23124 It is interior.Housing 23124 can be made up of such as low molecular weight gelatine, hyaluronic acid and/or CMC.Medicine 23121 can be manufactured such that micro- Grain, the particulate be can be distributed in solution and be poured into mould, and wherein solution for example can be freezed then, as described above.One Denier tissue thickness compensation part 23120 in use is exposed to liquid, and fluid 23129 (Figure 136) can enter compensating part main body Dissolve in 23122 and for example and/or the particle 23121 that absorbs the drug hydrophily housing 23124.Referring now to Figure 139, tissue is thick Degree compensating part 23220 may include first layer 23222 and the second layer or outer layer 23224, and the second layer or outer layer for example may include The particle 23221 for the multiple painting medicines being dispersed therein.It is similar as above, grain can be dissolved and/or absorbed from the second layer 23224 Son 23221, and such as opening or capillary pathway 23225 can be for example left in the second layer 23224.Referring now to Figure 140, Tissue thickness compensation part 23320 may include compensating part main body 23322, and the compensating part main body is therein more including being for example distributed in Individual drug particle 23121 and plurality of fibers 23021.

Referring now to Figure 141 and 142, nail bin 23400 may include that such as warehouse 23410 and the tissue being positioned on are thick Spend compensating part 23420.Tissue thickness compensation part 23420 may include to be positioned at multiple capsules in compensating part main body 23422 23421.Capsule 23421 is manufactured using such as emoulism or rotating disk technique, and capsule 23421 may include for example Solid and/or the microballoon of liquid bio metering.Capsule 23421 can include one or more adhesives, the one or more Adhesive can help to firm tissue encapsulation when being discharged from capsule 23421.Capsule 23421, which can be included, for example to stop blooding Agent.In any situation, capsule 23421 can be in any suitable manner distributed in compensating part main body 23422.Join now See Figure 143, capsule 23421 can be positioned in the cavity body of mould 21891 being for example defined in mould 21890, wherein capsule Agent 23421 can be deposited to the bottom 21893 of mould 21890.Referring to Figure 144, can swing die 21890 cause capsule 23421 Uniform or at least substantially uniform layer can be formed on bottom 21893.Referring now to Figure 145, compensating part main body can will be constituted 23422 material is poured into the cavity body of mould 21891 containing capsule 23421.Capsule 23421 is than compensating part material of main part Density is bigger, therefore, and capsule 23421 is positively retained at the bottom 21893 of mould 21890, as shown in Figure 146.For example, with reference to figure 148, the bottom 21893 of mould 21890 may include multiple grooves, depression and/or the scrobicula that can receive capsule 23421 21899.Alternatively, referring to Figure 147, capsule 23421 is smaller than compensating part material of main part density and can Float to the top of mould 21890.Optionally, described in greater detail below, the density of capsule 23421 can be selected as making The floatability of capsule 23421 is obtained in whole compensating part material of main part.

Mixture including capsule 23421 and compensating part material of main part is suitably being poured into it in mould 21890 Afterwards, mixture can undergo lyophilized technique for example to form tissue thickness compensation part 23420.For example, capsule 23421 can be fixed Or freeze in appropriate location in compensating part main body 23422.Then, can be by tissue thickness compensation part referring again to Figure 141 23420 remove from mould 21890, then are assembled on the warehouse 23410 of nail bin 23400.As shown in Figure 141, tissue thickness compensates Part 23420, which can be positioned and be arranged so that capsule 23421, can limit the tissue contacting surface of tissue thickness compensation part 23420 Or crust 23425, or be located near the tissue contacting surface of tissue thickness compensation part 23420 or crust 23425.Capsule Agent 23421 can be made up of such as hydrophilic material at least in part, be positioned in such as tissue thickness compensation part 23420 against tissue Afterwards, the hydrophilic material can quickly be dissolved and/or bio-absorbable.Each capsule 23421 can be with the time by multilayer Elapse and the material composition of dissolved and/or bio-absorbable.For example, the outer layer of capsule 23421 can include the first medicine, it is described First medicine can be dissolved and/or bio-absorbable and expose the second layer or internal layer, the second layer or internal layer comprising can for example with Afterwards be dissolved and/or bio-absorbable the second medicine.Some in capsule 23421 can be oriented so that when other ground of this paper Fang Suoshu cutting element is distally advanced to cut when tissue and/or tissue thickness compensation part 23420, and the capsule is cut Cut component cutting.Capsule 23421 can reduce the density of tissue thickness compensation part 23420, and this can for example reduce cutting element The power or energy being advanced through needed for tissue thickness compensation part 23420.

As described above, tissue thickness compensation part 23420 may include to be positioned at it is one or more in compensating part main body 23422 Capsule 23421 on side or crust.Also as described above, tissue thickness compensation part 23420 may include to be scattered in whole compensation Capsule 23421 in part main body 23422.For example, capsule 23421 there can be the equal densities of compensating part material of main part, make The floatability of capsule 23421 is obtained in compensating part material of main part.Capsule 23421 can be divided in whole compensating part material of main part Dissipate or homogenize, wherein can then cool down mixing before capsule 23421 is settled or at least substantially falls to mold bottom Thing.

Referring now to Figure 149, tissue thickness compensation part 23520 may include housing 23522 and be positioned in housing 23522 Multiple moving elements 23524.Housing 23322 can limit closed and/or sealed space, such as cavity 23523, in the chamber Body activity element 23524 is movable.Moving element 23254 can be such as spherical form, and can be for example relative to that This slides and/or rolled.Tissue thickness compensation part 23520 can be positioned above the warehouse 21310 of nail bin, wherein following closely 21330 It can be fired from nail bin and pass through tissue thickness compensation part 23520, as shown in Figure 150.In various scenarios, moving element 23524 It can move to and just be fired through the side of the nail 21330 of tissue thickness compensation part 23520 so that element 23524 can be Do not ruptured during percussion.For example, housing 23522 can be made up of elastomeric material, the elastomeric material can bend and/or shift With the power moved and dynamically redistribute internal generation of adaptive act element 23524.Housing 23522 can surround medium.Example Such as, medium may include moving element 23524 can in it for example one or more powder of motion, liquid, gas, fluid and/ Or gel.Moving element 23524 can be by for example can dissolve and/or bioabsorbable material and one kind contained therein or many Medicine is planted to constitute.For example, such construct can provide delay the and/or lasting release of one or more medicines.Make For another option, although not shown, but tissue thickness compensation part 23520 can be positioned on such as tissue T and anvil block 21060 it Between.In any situation, tissue thickness compensation part 23520 may include closed " beans bag " construction.Housing 23522 enables to it It will not rupture or at least substantially rupture, until cutting element such as cutting element 21380 is passed therethrough.Now, moving element One or more of 23524 can flee from housing 23522.

Referring now to Figure 153, tissue thickness compensation part 23620 may include compensating part main body 23622 and at least in part The multiple capsules 23624 being contained therein.Referring now to Figure 151, tissue thickness compensation part is manufactured using mould 23690 23620.For example, multiple ball-type capsule agent 23624 can be positioned in the cavity 23691 being defined in mould 23690, wherein glue Lateral movement of the wafer 23624 in mould 23690 can be for example, by the lateral side wall 23694 of mould 23690 and lateral The lateral block piece 23693 extended between side wall 23694 is prevented or stopped.Lateral side wall 23694 and lateral block piece 23693 can Limit the multiple pits that can be positioned in it and comprising capsule 23624.Capsule 23624 can be bearing on the bottom of mould 23690 On portion surface 23699.Alternatively, referring to Figure 151 and 152, mould 23690 may also include one or more longitudinal directions Support member 23692, one or more of vertical supports can hang capsule 23624 so that they not with mould 23690 Lower surface 23699 contact.For example, vertical supports 23692 can be positioned in lower surface 23699, and it is used as in addition Vertical supports 23692, referring to Figure 152, can be positioned on lateral supports 23693 by one kind selection.

Referring again to Figure 151 and 152, the material for constituting compensating part main body 23622 can be poured into the cavity of mould 23690 In 23691 so that capsule 23624 is at least substantially surrounded by the material.Referring primarily to Figure 153, capsule 23624 it is many Individual part can be from the projection of compensating part main body 23622 of tissue thickness compensation part 23620.Undergone in such as compensating part main body 23622 , can be by lateral supports 23693 and/or vertical supports 23692 from mould 23691 during or after lyophilized technique Withdraw from.Now, capsule 23624 can be suspended in compensating part main body 23622 without structural support.Alternatively select Select, lateral supports 23693 and/or vertical supports 23692 are positively retained in compensating part main body 23622.For example, lateral support Part 23693 and/or vertical supports 23692 can be made up of for example bioabsorbable material.Support member 23692 and/or support Part 23693 may include the elastic component being positioned in compensating part main body 23622, and this can for example increase compensating part main body 23622 Elasticity.

Referring now to Figure 157, tissue thickness compensation part 23720 may include compensating part main body, and the compensating part main body has At least one capsule 23724 of Part I 23722a and Part II 23722b and positioning therebetween.Tissue thickness is mended Part 23720 is repaid to manufacture using such as mould 21890.Referring now to Figure 154, the first material can be poured into mould 21890 To form the Part I 23722a of compensating part main body.Then, referring to Figure 155, capsule 23724 can be positioned at Part I On 23722a.After such as certain period of time and/or after the first material experience lyophilized technique, capsule 23724 can be determined Position is on Part I 23722a.Referring now to Figure 156, the second material can be poured into mould 21890 to form compensating part The Part II 23722b of main body., can be such as after such as certain period of time and/or after the second material experience lyophilized technique Tissue thickness compensation part 23720 is taken out from mould 21890 and is used in combination with nail bin 23700, as shown in Figure 158.Second material Material may differ from the first material, and alternatively, the second material can be identical with the first material.In either case, For example, the first material and/or the second material can be made up of bioabsorbable material, and capsule 23724 can be by least one Medicine is planted to constitute.

Referring now to Figure 162, nail bin 23800 may include tissue thickness compensation part 23820, and the tissue thickness compensation part can Including compensating part main body 23822 and it is positioned at longitudinal capsule 23824 therein.Referring now to Figure 159 and 160, it can pass through Any suitable technique forms vertical such as by mechanical drilling process and/or laser drilling process in compensating part main body 23822 To hole 23821.Once forming longitudinal hole 23821, so that it may which longitudinal capsule 23824 is positioned in longitudinal hole 23821, such as scheme Shown in 161.Referring now to Figure 166, nail bin 23900 may include tissue thickness compensation part 23920, and the tissue thickness compensation part can Including compensating part main body 23922 and it is positioned at multiple horizontal capsules 23924 therein., can referring now to Figure 163 and 164 By any suitable technique such as by mechanical drilling process and/or laser drilling process, the shape in compensating part main body 23922 It is open into hole 23921.Once form transverse holes 23921, so that it may which multiple horizontal capsules 239824 are positioned at transverse holes 23921 It is interior, as shown in Figure 165.

Figure 167-171 shows to manufacture alternative side of tissue thickness compensation part 23820 using vertical mould 24090 Method.Referring primarily to Figure 167, mould 24090 may include the cavity 24091 limited by side wall 24092 and base end wall 24093.Referring to Figure 168, end wall 24093 may include hole 24094, and the hole can receive the end of longitudinal capsule 23824 and by capsule 23824 are maintained in stand up position, as shown in Figure 169.Then, can be closed and/or close by lid 24095 referring now to Figure 170 Seal the open side of cavity 24091 so that the material for constituting compensating part main body 23822 can incline by the openend of mould 24090 Note in cavity 24091., can be by tissue thickness after for example constituting the material solidification of compensating part main body, solidifying and/or be lyophilized Compensating part 23820 takes out from mould 24090.

Referring now to Figure 172, nail bin 24100 may include that warehouse 24110, the platform surface 24111 against warehouse 24110 are determined The tissue thickness compensation part pad 24170 of position and the tissue thickness's compensation being positioned on the top of tissue thickness compensation part pad 24170 Part 24120.Tissue thickness compensation part 24120 and tissue thickness compensation part pad 24170 can together or independently compensating nail such as from The thickness change of the tissue of capture in the nail 21330 (Figure 175) that nail bin 24100 is fired.Referring primarily to Figure 172 and 173, compensating part Pad 24170 may include the lower surface 24171 for being capable of abutment platforms surface 24111 and extend in addition from lower surface 24171 Attachment flange or guide rail 24174, it is described attachment flange or guide rail can be fixedly received at the knife being defined in warehouse 24110 In slit 24114.Compensating part pad 24170 may also include multiple packages 24172, and the multiple package extends transversely across compensation Part pad 24170.For example, each package 24172 can be limited along axis of pitch, the axis of pitch transverse to and/or perpendicular to The longitudinal axis limited by cutter slit 24114, as shown in Figure 176.Compensating part pad 24170 may include multiple layers, the multiple Package 24172 can be limited between layer.For example, the layer can be made up of such as PDS and/or collagen.Each package 24172 can be Wherein store one or more medicines, such as fortimicin, coagulant and/or antimicrobial material.

Referring again to Figure 175, tissue thickness compensation part pad 24170 can be positioned relative to warehouse 24110 so that package 24172 are covered in the nail cavity 21312 being defined in warehouse 24110.More particularly, each package 24172 can be positioned and It is arranged so that it extends between the nail leg 21332 of nail 21330.Compensating part pad 24170 may include multiple holes and/or through hole, The multiple hole and/or through hole can receive the end of such as nail 21330.It is attached that these through holes can be positioned on such as package 24172 Closely.When never firing position moves to firing position to nail 21330, as shown in Figure 175, nail 21330 can catch package 24172 Obtain wherein.For example, nail 21330 and package 24172 and can be arranged such that package 24172 is not in percussion nail 21330 Pierced or rupture.In such situation, package 24172 can provide elasticity to tissue T of the capture in nail 21330 or compression is pressed Power, and the gap between such as tissue T and nail 21330 can be occupied.Referring again to Figure 176, worn when cutting element 21380 is promoted When crossing the cutter slit 24114 being defined in warehouse 24110, tissue T and/or compensating part pad 24170, package 24172 can be cut Component 21380 is cut.Reader will note that not shown to tissue thickness compensation part 24120 in Figure 175 and 176.Contemplate various Embodiment, wherein nail bin 24100 include tissue thickness compensation part pad 24170 and do not include tissue thickness compensation part 24120, and Alternatively, referring now to Figure 177, nail bin 24100 may include such as tissue thickness compensation part pad 24170 and tissue Both thickness compensation parts 24120.

The alternative embodiment of nail bin is shown in Figure 178.According to the present invention, circular nail bin 24200 may include circular storehouse Body 24210, the circular warehouse is included for example with multiple nail cavities 21312 of arranged in concentric circles.For example, nail bin 24200 can also be wrapped The circular tissue thickness compensation part pad 24270 being positioned on warehouse 24210 is included, wherein compensating part pad 24270 may include such as footpath To the package 24272 stretched out.Similar as above, package 24272 can be upwardly extended in the side being covered in nail cavity 21312, So that package 24272 can extend between the leg for the nail 21330 being positioned in nail cavity 21312.Also it is similar as above, when from nail bin During 24200 percussion nail 21330, nail 21330 can capture package 24272 wherein.

Referring now to Figure 189, nail bin 24300 may include warehouse 24310 and tissue thickness compensation part 24320, the tissue Thickness compensation part includes compensating part main body 24322 and the multiple tubular elements 24324 being positioned in compensating part main body 24322. For example, nail bin 24300 may also include the tissue thickness being for example positioned between tissue thickness compensation part 24320 and warehouse 24310 Compensating part layer or sheet material 24370.Referring now to Figure 179, multiple nail bins 24300 can simultaneously be manufactured using mould 24390.Mould 24390 may include multiple cavities 24391, and the multiple cavity can each receive warehouse 24310 wherein, as shown in Figure 180. Then, the one or more big material pieces for constituting tissue thickness compensation part layer 24370 can be placed on above warehouse 24310.Mould Tool 24390 may include multiple supporting pins upwardly extended or post 24392, wherein sheet material 24370 can be positioned against post 24392, Then push down on so that post 24392 can pierce sheet material 24370, as shown in Figure 181 and 183.Referring now to Figure 182 and 184, One or more elongated tubulars 24324 can be wound on around and between post 24392 so that pipe 24324 cross each warehouse 24310 to Less once.Pipe 24324 can be wound on around and between post 24392 so that pipe 24324 crosses each warehouse 24310 such as six times. Pipe 24324 can be allowed to be bearing on sheet material 24370, and pipe 24324 also can be tightly wound on around and between post 24392 so that pipe 24324 tighten and can be suspended on sheet material 24370., can be by structure once pipe 24324 is properly positioned, referring primarily to Figure 185 Material into compensating part main body 24322 is poured on the top of sheet material 24370 in mould 24390.Sheet material 24370 can protect or Warehouse 24310 is sheltered, and can prevent compensating part material of main part 24322 from entering the nail cavity being for example defined in warehouse 24310 In 21312.According to the present invention, the compensating part material of main part 24322 of sufficient amount can be poured into mould so that compensating part main body Material 24322 covers elongated tubular 24322.

Further described above, compensating part material of main part 24322 then can be made for example to solidify, solidify and/or frozen It is dry, to form tissue thickness compensation part 24320 on the top of warehouse 24310.Then, referring now to Figure 186, using blanking punch First 24395 cutting compensating part material of main part 24322, tissue thickness compensation part sheet material 24370 and elongated tubular 24322.Referring now to Figure 187, cutting die head 24395 may include multiple cutting blades 24396, and the multiple cutting blade can compensate tissue thickness Part 24320 and tissue thickness compensation part sheet material 24370 are splitted into single and departed from each other.Cutting die head 24395 may include multiple Well 24397, the multiple well, which can be removed, splits into single tissue thickness compensation part 24320 and tissue thickness compensation part sheet material Any excess stock between 24370, as shown in Figure 188.Cutting die head 24935 and/or any other suitable die head can be wrapped For example one or more heating element heaters are included, one or more of heating element heaters are capable of seal tissue thickness compensation part 24320 End and/or edge.Pipe 24324 can be filled with one or more fluids.In such situation, cutting blade 24396 can be cut Pipe cutting 24324, while the end of the tube portion included in seal tissue thickness compensation part 24320.Then, can will be described many Individual nail bin 24300 takes out from mould.

Referring now to Figure 190 and 191, nail bin 24400 may include warehouse 24410, and the warehouse can be removed wherein Ground stores multiple nails.In addition, nail bin 24400 may also include tissue thickness compensation part 24420.Tissue thickness compensation part 24420 can Including the compensating part main body being made up of multiple layers 24422, its middle level 24422 can be made up of such as cellulose membrane.Such as Figure 192 institutes Show, material 24424 can be positioned between two or more adjacent layers 24422, wherein material 24424 can be with adjacent layer 24422 are spaced apart from each other.Material 24424 can include blend polymer biomedics extrudates, and material 24424 can be wrapped Include such as hemostatic material, anti-inflammatory material and/or antibiotic materials., can be by distributor 24490 with for example referring now to Figure 192 Material 24424 is applied on layer 24422 by waveform patterns, wherein the waveform patterns enable to material 24424 can be positioned on It is defined in above one or more of warehouse 24410 nail cavity.In such situation, material 24424 can be captured and penetrated from nail cavity In the nail gone out, and elastic bias force is provided to the tissue also captured in nail.In any situation, one or more layers 24422 For example it can be vacuum formed and/or heat seal on material 24424 to form tissue thickness compensation part 24420.Then can be by group Knit thickness compensation part 22420 and cut to certain length.Various embodiments are contemplated, wherein tissue thickness compensation part 22420 is abutted The platform surface positioning of nail bin, and another tissue thickness compensation part 22420 abuts anvil positioning.

Referring now to Figure 195, nail bin 24600 may include to be positioned at one or more tissue thicknesses above warehouse 24610 Compensating part 24620.Referring primarily to Figure 194, each tissue thickness compensation part 24620 may include multiple layers 24622 and be positioned at Compressible or collapsible component 24624 between layer 24622.Collapsible component 24624 may include corrugated component, the ripple Shape component includes being defined in multiple pits therein, and one or more of which medicine can be stored in pit.For example, can be by first Medicine is placed in the pit in the first side of corrugated component, and for example, the second medicine can be placed on into corrugated structure In pit in the second side of part.When layer 24622 and compressible member 24624 are compressed together for example, by roller 24590, Tissue thickness compensation part 24620 can be formed.Referring now to Figure 193, tissue thickness compensation part 24520 can be formed by tubes of material, institute State tubes of material and the flat shape in part is rolled into by such as roller 24590.Referring now to Figure 196 and 197, warehouse 24610 is positioned at Interior nail 21330 can be from its injection so that nail 21330 can capture at least a portion of tissue thickness compensation part 24620 at it In.In such situation, compressible member 24624 can apply elastic biasing against the tissue T also captured in nail 21330 Power.The layer 24622 of tissue thickness compensation part 24620 also can apply elastic bias force against tissue T.The pierceable ripple of nail 21330 The pit of line shape component 24624 simultaneously discharges one or more medicines contained therein.

Above-mentioned tissue thickness compensation part can include material wherein.The material may include such as coagulant, medicine and/or Antiinflammatory.The material can be liquid, but can also take other forms, such as solid and/or gel.For including this class loading For the surgical device of thickness compensation part, it can be advantageous that surgical device includes the material being guided out tissue thickness's compensation The structure of part.For example, can by the material from tissue thickness compensation part towards cutting and suture guide.And for example, first group Knitting thickness compensation part may include the first material, and second thickness compensating part may include the second material, wherein the first and second things Matter can be mixed by surgical device., can be by the material away from each other, towards such as nail bin and/or outwardly as another example The anvil block guiding of section's device.

Figure 61-62 shows surgical stapling system, and the surgical stapling system includes the cutting blade with cutting blade 19016 19000th, nail bin 19002, anvil block 19008, the first tissue thickness compensation part 19004 that is positioned on nail bin 19002 and positioning Minor microstructure thickness compensation part 19006 on anvil block 19008.In use, cutting blade 19000 is in the direction of arrow D Move to cut patient tissue T and the first tissue thickness compensation part 19004 and minor microstructure thickness compensation part towards distal side 19006.The first tissue thickness compensation part 19004 has the material S included in it, and minor microstructure thickness compensation part 19006 With the material S ' included in it.The first tissue thickness compensation part 19004 includes the encapsulation piece containing material S in it.Encapsulation piece It may include the material membrane cut by the cutting film of cutting blade 19000, wherein material S discharges when film is cut open.Second group Knitting thickness compensation part 19006 may include similar encapsulation piece, and the second material S ' can be in minor microstructure thickness compensation part 19006 Encapsulation piece be cut blade 19000 cut when discharge.When blade 19000 is moved towards distal side, guider 19030 and 19022 Can guide or shift respectively material S from the first tissue thickness compensation part 19004 and minor microstructure thickness compensation part 19006 and S’.For example, material S and S ' can be guided towards the tissue T of cutting.Blade 19000 can be connected to axle 19012, and the axle then may be used Actuating mechanism is connected to, the actuating mechanism makes blade 19000 on distal direction D and in the proximal direction indicated by arrow P Upper motion.

Guider 19030 can guide the material S from the first tissue thickness compensation part 19004 towards the tissue T of cutting.Lead On the opposite face that blade 19000 is can be positioned on to the mirror image of device 19030.Guider 19030 may include to limit the two of channel C therebetween Individual boss ridge 19032 and 19034.When surgical stapling device is positioned against tissue T, the distal end 19035 of channel C can be positioned on The nearside of the first tissue thickness compensation part 19004, and the proximal extremity 19037 of channel C can be positioned on the nearside of tissue T. In use, when cutting blade 19000 is moved on distal direction D, the material S from the first tissue thickness compensation part 19004 Enter channel C at distal end 19035, flow through channel C, and the leaving channel C at the proximal extremity 19037 of tissue T nearside.

Guider 19022 can guide the material S ' from minor microstructure thickness compensation part 19006 towards the tissue T of cutting. Guider 19022 includes the projection 19025 with inclined surface 19023.As shown in Figure 61, projection 19025 is pierceable or cuts Minor microstructure thickness compensation part 19006 is with h substance S '.When blade 19000 is moved towards distal side D, inclined surface 19025 can Material S ' is guided towards tissue T.

Material S and S ' can be mixed when being guided towards tissue T.Material S and S ' can be different, and can be reacted in mixing.Example Such as, material S and S ' can be chemically reacted to form novel substance S " in mixing.Novel substance S " can for such as medicine, antibiotic, The material of coagulant and/or any other suitable type.After blade 19000 is suitably promoted on distal direction D, blade 19000 can be moved and be returned by proximally P, and wherein the proximal movement of blade 19000 can further compounding substances S and S '.

Alternatively, guider 19022 and 19030 can guide material S and S ' away from tissue T.For example, Guider 19030 can guide material S towards nail bin 19002, and guider 19022 can be by material S ' towards anvil block 19008 Guiding.If for example, the first tissue thickness compensation part 19004 is held in into nail at such as junction surface 19005 by adhesive Storehouse 19002, and if be held in minor microstructure thickness compensation part 19906 at such as junction surface 19007 by adhesive Anvil block 19008, then such construct is probably favourable.Material S and S ' can dissolve or neutralize adhesive, so that the first tissue is thick Degree compensating part 19004 and minor microstructure thickness compensation part 19006 are released at least in part from nail bin 19002 and anvil block 19008 respectively Put.

Figure 63 shows alternative guider 19030 ', wherein channel C ' by the depression or ditch in the surface of blade 19014 Groove is limited.Channel C ' it may include single passage or may include multiple passages.

Figure 64-67 shows another surgical stapling system, and the surgical stapling system includes cutting blade 19060 and cutting blade 19056th, the first tissue thickness compensation part 19004 and minor microstructure thickness compensation part 19006.Blade 19060 may include blade The first projection 19062 in 19060 first side, wherein the first projection 19062 limits cavity 19064, the cavity is from knife The first side of piece 19060 passes through the second side of blade 19060.First projection 19062 and the first cavity 19064 can be with The first tissue thickness compensation part 19004 is aligned.In use, when blade 19060 is moved towards distal side, the first tissue thickness compensation At least a portion of material S in part 19004 may pass through the first cavity 19064.Optionally, the profile of the first projection 19062 can Material S is guided to the second side of blade 19060 and/or guided towards tissue T.

Blade 19060 may also comprise the second projection 19066 in the second side of blade 19060, wherein the second projection is limited Determine cavity 19068, the second side of the cavity from blade 19060 passes through the first side of blade 19060.Second projection 19066 and second cavity can be aligned with minor microstructure thickness compensation part 19006.In use, when blade 19060 is moved towards distal side When, at least a portion of the material S ' in tissue thickness compensation part 19006 may pass through the second cavity 19068.Optionally, second dash forward Playing 19066 profile can guide to the first side of blade 19060 by material S ' and/or be guided towards tissue T.

Referring primarily to Figure 64 and 65, axle 19059 may include surface texture, can such as increase material S and S ' turbulent flow and/or The scrobicula 19070 of discharge capacity.For example, increased turbulent flow and/or discharge capacity can cause larger portion of material S and S ' to be in contact with each other.It is shallow Recessed 19070 can be positioned on the nearside relative to cavity 19064 and 19068.When blade 19000 is promoted towards distal side, scrobicula 19070 The downstream of cavity 19064 and 19068 can be located at；However, when blade 19000 proximally bounces back, scrobicula 19070 can be located at cavity 19064 and 19068 upstream.

Figure 68-70 shows another surgical stapling device, and the surgical stapling device includes blade 19100 and cutting blade 19108, the One tissue thickness compensation part 19120 and minor microstructure thickness compensation part 19122.The first tissue thickness compensation part 19120 can be wrapped Containing the first material S and the second material S '.For example, the first material S may be included in above-mentioned first encapsulation piece.Second material S ' can be filled It is loaded in the second encapsulation piece, second encapsulation piece can be in the first encapsulation piece nearside and/or around the first encapsulation piece.Minor microstructure Thickness compensation part 19122 can include the 3rd material S ".Minor microstructure thickness compensation part 1922 can include the 4th material S " '.3rd Material S " and the 4th material S " ' can be loaded into encapsulation piece, such as above-mentioned encapsulation piece.Blade 19100 may include blade 19,100 first Grain surface 19110 on 19102, material S, S sideways ', S " and S " ' may be interspersed within the whole grain surface.Another Grain surface can be located on the opposing second side (not shown) of blade 19100.Grain surface 19110 may include a series of interruptions Structure, cutting, cut, etching and/or the groove in other words formed such as in first surface 19102.Interrupt structure also may be used Including a series of bulge-structures on such as first surface 19102, such as boss ridge.As shown in Figure 68-70, grain surface 19110 interrupt structure may include the regular repeating pattern of interrupt structure.Interrupt structure can also non-repeating pattern set or with Machine is set.

Blade 19100 may also comprise the second surface 19104 being positioned at relative to the nearside of first surface 19102.Second Surface 19104 can be raised relative to first surface 19102.Junction surface between first surface 19102 and second surface 19104 can The 3rd surface 19106 is limited, wherein the 3rd surface 19106 can be angularly positioned relative to the longitudinal axis of blade 19100.Blade 19100 motion on distal direction D can cause the first end 19107 on the 3rd surface 19106 the of the 3rd surface 19106 The front of two end 19109 is guided.Therefore, as shown in Figure 70, the 3rd surface 19106 can make to come from the first tissue thickness compensation part 19120 material S and S ' is guided towards the tissue T of cutting.Surface 19105, it is similar to second surface 19104, blade can be located at On 19100 opposing second side.

Blade 19100 shown in Figure 68-70 can be used in surgical device, and the surgical device includes institute in Figure 61-67 The first tissue thickness compensation part 19004 and minor microstructure thickness compensation part 19006 shown.As described above, grain surface 19110 can Material S and S ' from respective tissue thickness compensation part 19004 and 19006 are distributed on the first surface 19102 of blade, made Obtaining them can mix and can be positioned near tissue T.

Blade 19100 shown in Figure 68-70 can also be used for surgical device, and the surgical device is included shown in Figure 68-70 The first tissue thickness compensation part 19120 and minor microstructure thickness compensation part 19122.The first tissue thickness compensation part 19120 can Interior section 19121 including including the first material S.When the first tissue thickness compensation part 19120 is by the cutting blade of blade 19100 During 19108 cutting, material S can discharge from interior section 19121.When blade 19100 is transported relative to tissue thickness compensation part 19120 When dynamic, material S may be interspersed within grain surface 19110, and the 3rd surface 19106 can guide material S towards tissue T.As above Described, the first tissue thickness compensation part 19120 can internally include the second material S ' outside part 19121.When the first tissue is thick When degree compensating part 19120 is cut by the cutting blade 19108 of blade 19100, the first material S and the second material S ' can be distributed in texture table On face 19110.Distribution on grain surface 19110 can be such that the first material S is mixed with the second material S '.When mixing, the first thing Matter S can react with the second material S ', such as chemically react, so as to form novel substance.3rd surface 19106 can be by the first material S Guided with the second material S ' courts.As described above, minor microstructure thickness compensation part 19122 can include the 3rd material S ".When When two tissue thickness compensation parts 19122 are cut by the cutting blade 19108 of blade 19100, the 3rd material S " can be distributed in grain surface On 19110, on the grain surface, it can be mixed with the first material S and/or the second material S ', and be guided towards tissue T.Such as Upper described, minor microstructure thickness compensation part 19122 can include the 4th material S " '.When minor microstructure thickness compensation part 19122 is by knife When the cutting blade 19108 of piece 19100 is cut, the 3rd material S " and the 4th material S " ' can be distributed on grain surface 19110, in institute State on grain surface, they can be with the first material S, the second material S ' and/or being mixed with each other, and can be guided towards tissue T.

Further described above, tissue thickness compensation part can be made up of biocompatible materials.Biocompatibility Material (such as foam) may include tackifier, surfactant, filler, crosslinking agent, pigment, dyestuff, antioxidant and other Stabilizer and/or combinations thereof, with characteristic needed for being provided for material.Biocompatible foam may include surfactant.Table Face activating agent can be applied to material surface and/or be dispersed in material.Any particular theory is not intended to be limited to, is applied to The surfactant of biocompatible materials can reduce the surface tension of the fluid of contact material.For example, surfactant can With the surface tension for the water for reducing contact material, to accelerate water to penetrate into material.Water can serve as catalyst.Surfactant can be with Improve the hydrophily of material.

Surfactant may include anion surfactant, cationic surfactant and/or non-ionic surface active Agent.The example of surfactant includes but is not limited to polyacrylic acid, methyl cellulose (methalose), methylcellulose, ethyl Cellulose, propyl cellulose, hydroxyethyl cellulose, carboxymethyl cellulose, PCE, polyoxyethylene laural base Ether, polyoxyethylene octyl ether, NONIN HS 240, polyoxyethylene oleyl ether, polyoxyethylene sorbitan Dan Yue Cinnamic acid ester, polyoxyethylene stearyl base ether, ethylene nonyl phenyl ether, dialkylphenoxypoly (ethyleneoxy) ethanol and pool Lip river Sha Mu, and combinations thereof.Surfactant may include the copolymer of polyethylene glycol and polypropylene glycol.Surfactant can be wrapped Include non-phospholipid surfactants.Non-phospholipid surfactants can provide antibacterial stability and/or other materials is dispersed in into bio-compatible In property material.

Tissue thickness compensation part can include at least one medicine.Tissue thickness compensation part may include natural material as described herein One or more of material, non-synthetic materials, and/or synthetic material.Tissue thickness compensation part may include biocompatible foam, The biocompatible foam includes gelatin, collagen, hyaluronic acid, oxidized regenerated cellulose, polyglycolic acid, polycaprolactone, poly- Lactic acid, polydioxanone, polyhydroxyalkanoatefrom, Poliglecaprone and combinations thereof.Tissue thickness compensation part may include Film, the film includes at least one medicine.Tissue thickness compensation part may include Biodegradable films, and the Biodegradable films are comprising extremely A kind of few medicine.Medicine may include liquid, gel and/or powder.Medicine may include anticancer, such as cis-platinum, mitomycin and/ Or adriamycin.

Tissue thickness compensation part may include biodegradation material, to provide at least one medicine when biodegradation material is degraded The controlled elution of thing.When biodegradation material contacts activator such as activating solution, biodegradation material can degrade, Ke Yifen Solution, or lose structural intergrity.For example, activating solution may include saline solution or any other electrolyte solution.Biodegradable material Material can contact activating solution by routine techniques, and the technology includes but is not limited to spraying, dipping and/or brushing.In use, For example, surgeon can will include the end effector and/or nail bin of tissue thickness compensation part (it includes at least one medicine) Immerse in activating solution, the activating solution includes salting liquid, such as sodium chloride, calcium chloride, and/or potassium chloride.Tissue thickness compensates Part can discharge medicine when tissue thickness compensation part is degraded.Medicine can be quickly from the feature of the elution of tissue thickness compensation part Initial eluting rate and at a slow speed persistently eluting rate.

According to the present invention, tissue thickness compensation part can be for example made up of biocompatible materials, the biocompatibility material Material may include oxidant.Oxidant can be organic peroxide and/or inorganic peroxide.The example of oxidant may include but not It is limited to hydrogen peroxide, urea peroxide, calper calcium peroxide and peromag, and SODIUM PERCARBONATE.Oxidant may include that peroxy is aoxidized Agent and hypohalite-based oxidant, such as hydrogen peroxide, hypochlorous acid, hypochlorite, hypocodites and percarbonate.Oxygen Agent may include alkali metal chlorate, hypochlorite and perborate, such as sodium chlorite, sodium hypochlorite and sodium perborate.Oxygen Agent may include vanadate.Oxidant may include ascorbic acid.Oxidant may include active oxygen generator.According to the present invention, group Knitting support may include biocompatible materials, and the biocompatible materials includes oxidant.

Biocompatible materials may include liquid, gel and/or powder.For example, oxidant may include particulate and/or nanometer Particle.For example, oxidant can grind to form particulate and/or nano-particle.Can be by the way that oxidant be suspended in a polymer solution And oxidant is attached in biocompatible materials.Oxidant can be attached to biocompatible materials during lyophilized technique In.After lyophilized, oxidant could attach to the cell membrane of biocompatible materials, with contact and tissue interaction.Oxygen Agent can not be chemically bonded to biocompatible materials.Percarbonate dry powder can be embedded in biocompatible foam, with logical Too slow On The Drug Release oxygen provides long-term biological effects.Percarbonate dry powder can be embedded in the polymer fiber in non-woven structure It is interior, to provide long-term biological effects by slowly discharging oxygen.Biocompatible materials may include oxidant and medicine, such as strength Mycin and ascorbic acid.

Biocompatible materials may include quick release oxidant and/or at a slow speed sustained release oxidant.Oxidant is from life The feature of the elution of thing compatibility material can be quick initial eluting rate and continue eluting rate at a slow speed.When oxidant contacts body fluid When (such as water), oxidant can generate oxygen.The example of body fluid may include but be not limited to blood, blood plasma, peritoneal fluid, myelencephalon Liquid, urine, lymph, synovia, vitreous humor, saliva, gastrointestinal cavity content and/or bile.It is not intended to be limited to any specific Theory, oxidant can reduce cell death, and enhancing organizational vitality and/or maintenance can be broken in cutting and/or sewing process The mechanical strength of bad tissue to tissue.

Biocompatible materials may include at least one particulate and/or nano-particle.Biocompatible materials may include this One or more of natural material, non-synthetic materials and synthetic material described in text.Biocompatible materials may include average A diameter of about 10nm to about 100nm and/or about 10 μm to about 100 μm, such as 45-50nm and/or 45-50 μm of particle.It is biological Compatibility material may include biocompatible foam, and the biocompatible foam includes at least one particulate being embedded And/or nano-particle.Particulate and/or nano-particle can not be chemically bonded to biocompatible materials.Particulate and/or nano-particle The controlled release of medicine can be provided.Particulate and/or nano-particle can include at least one medicine.For example, particulate and/or nanometer Particle can include styptic, antimicrobial and/or oxidant.Tissue thickness compensation part may include biocompatible foam, institute State biocompatible foam comprising styptic (it includes oxidized regenerated cellulose), antimicrobial (it include fortimicin with/ Or gentamicin) and/or oxidant (it includes percarbant).For example, particulate and/or nano-particle can provide up to three The controlled release of it medicine.

Particulate and/or nano-particle can be embedded in biocompatible materials in the fabrication process.For example, biocompatibility Polymer (such as PGA/PCL) can contact solvent (such as dioxane) to form mixture.Biofacies can be ground Capacitive polymer is to form particle.It can be contacted with or without the dried particle of ORC particles with mixture to form supensoid agent.Should Supensoid agent can be lyophilized to form biocompatible foam, and the biocompatible foam is included with the dried particle being embedded And/or the PGA/PCL of ORC particles.

For example, tissue thickness compensation part disclosed herein or layer can be made up of absorbable polymer.For example, tissue is thick Spending compensating part can be constituted by the following substances：Foam, film, fibrous woven materials, fiber non-woven PGA, PGA/PCL (poly- (ethanol Sour -co- caprolactone)), PLA/PCL (poly- (lactic acid -co- polycaprolactone)), PLLA/PCL, PGA/TMC (poly- (glycolic -co- three Carbonate)), it is PDS, PEPBO or other absorbable polyurethane, polyester, makrolon, poe, condensing model, poly- Esteramides, and/or polyoxy acid ester.According to the present invention, for example, tissue thickness compensation part can by PGA/PLA (it is poly- (glycolic- Co- lactic acid)) and/or PDS/PLA (poly- (to dioxanone -co- lactic acid)) compositions.According to the present invention, for example, tissue is thick Degree compensating part can be made up of organic material.For example, tissue thickness compensation part can be by carboxymethyl cellulose, mosanom, cross-linked transparent Matter acid, and/or oxidized regenerated cellulose are constituted.According to the present invention, for example, tissue thickness compensation part may include 3-7 Shore As (30- 50 Shore OO) in the range of hardness, wherein maximum rigidity be 15 Shore As (65 Shore OO).For example, tissue thickness compensation part can be 40% compression is subjected under the load of 3 ft lbfs, 60% compression is subjected under the load of 6 ft lbfs, and/or be subjected under the load of 20 ft lbfs 80% compression.One or more gases (such as air, nitrogen, carbon dioxide and/or oxygen) can for example blast and/or comprising In tissue thickness compensation part.Tissue thickness compensation part can be described small wherein comprising the globule for constituting tissue thickness compensation part Pearl includes the material stiffness between about 50% and about 75%.

According to the present invention, for example, tissue thickness compensation part can include hyaluronic acid, nutrient, fibrin, blood coagulation Enzyme, platelet rich plasma, 4-sulfanilamidosalicylic acid azine (- 5ASA+ sulfadiazine diazo bonds)-prodrug-colon bacteria (azo reductase), mesalazine (5ASA, with the different prodrug configurations for sustained release),(5ASA+Eudragit- S coatings-pH>7 (being coated dissolving)),(5ASA+ ethylcellulose coats-time/pH dependences sustained release),(5ASA+Eudragit-L coatings-pH>6), Olsalazine (5ASA+5ASA-colon bacteria (azo reductase)), Balsalazide (5ASA+4 amino benzoyl-B- alanine)-colon bacteria (azo reductase)), granular mesalazine, Lialda (Chinese medicine that can suppress TNF-α, Interleukin -1β and nuclear factor kB activation is closed by (the delay sustained release preparation of mesalazine), HMPL-004 Agent), CCX282-B (interference T lymphocyte transmigrations oral chemokine receptor antagonist) into intestinal mucosa, rifaximin (no Absorbable broad-spectrum antibiotic), infliximab, mouse source is chimeric (is directed to the monoclonal antibody of TNF-α, it is approved for To mitigating in adult/pediatric patients with moderate/severe tube chamber and fistula type Crohn disease of routine treatment inadequate response Symptom/symptom simultaneously keeps clinical remission), adalimumab, (anti-tnf-alpha monoclonal antibody, it is approved for full humanized IgG 1 Mitigate symptom/symptom of Crohn disease, and for routine treatment inadequate response or not tolerating the trouble of infliximab Have in the adult patients of moderate/severe activity Crohn disease induce and keep clinical remission), match trastuzumab, humanization resist TNF FAB ' (monoclonal antibody fragment of polyethylene glycol is connected to, it is approved for the symptom/symptom for mitigating Crohn disease, And in the adult patients with moderate/severe disease to routine treatment inadequate response induce and keep respond), that His pearl monoclonal antibody, initial non-TNF-α inhibitor (biologic artifact for being approved for Crohn disease), Humanized monoclonal IgG4 resist Body (is directed to α -4 integrins, it ratifies to be used to have signs of inflammation and suppress conventional treatment of Crohn s disease and TNF-α through FDA Agent inadequate response or the patient with moderate/severe disease for not being resistant to conventional treatment of Crohn s disease and TNF-α inhibitor Middle induction and keep clinical response and alleviation), concomitant immunity conditioning agent, the sulphur azoles that may be given together with infliximab it is fast Purine 6-MP (purine synthetic inhibitor-prodrug), methotrexate (MTX) are (with reference to the dihyrofolate reductase for participating in tetrahydrofolic acid synthesis (DHFR), suppress the synthesis of all purine), allopurinol and sulphur purine therapy, for acid suppression to protect the PPI of healing line, it is H2, difficult Difficult clostridium-metronidazole, vancomycin (faecal microbiota displacement treatment, probiotics, in normal chamber flora population recovery), and/or Rifaximin (treatment bacterial overgrowth (especially hepatic encephalopathy)；It is not absorbed in intestines and stomach, intracavitary bacterium is worked).

It is as described herein, for example, tissue thickness compensation part can compensate be trapped in it is being projected from nail bin and/or comprising The change of the thickness of the tissue in nail in staple line.In other words, some nails in staple line can capture the thicker of tissue Point, and other nails in staple line can capture the thinner part of tissue.In this case, tissue thickness compensation part can be in nail Different height or thickness is presented, and apply compressive force to the tissue being trapped in nail regardless of whether captured tissue be it is thick or It is thin.According to the present invention, tissue thickness compensation part can compensate for the change of tissue hardness.For example, some nails in staple line can be captured The highly compressible portion of tissue, and other nails in staple line can capture the compressibility smaller ones of tissue.In this feelings Under condition, for example, smaller height can be presented in tissue thickness compensation part in nail (it has captured the tissue with relatively low compressibility) Degree or higher hardness, and correspondingly, larger height can be presented in nail (it has captured the tissue with higher compressibility) Spend or compared with soft.Under any circumstance, for example, no matter tissue thickness compensation part whether compensate tissue thickness change and/or The change of tissue hardness, it is referred to alternatively as " Tissue compensating part " and/or " compensating part ".

Device disclosed in this invention can be designed as being handled after being intended for single use, or can be designed as them can It is used for multiple times.However, in either case, described device can be repaired, to be reused after use at least one times.Repair It may include any combination of following steps again：Dismounting described device and then cleaning are replaced particular elements and then filled again Match somebody with somebody.Particularly, described device can be disassembled, and optionally can replace or take out in any combination the Arbitrary Digit of described device Purpose particular elements or part.Cleaning and/or replace particular elements after, described device can at restoration facilities or It will carry out before surgical operation ressembling then to use by operating team.Those skilled in the art will be understood that, fill The reparation put can utilize it is a variety of be used to dismantling, the technology for cleaning/replace and ressemble.The uses of these technologies and gained It is repaired device within the scope of the present invention.

Preferably, invention as described herein will be handled before surgery.First, new or used device is obtained Tool, and apparatus is cleaned when necessary.Then apparatus is carried out disinfection.In a kind of disinfection technology, the apparatus is put In closure and sealedly container, such as in plastics or TYVEK bag.Then the container can be penetrated by being placed in container and apparatus Radiation field in, such as γ radiation, x- rays or high energy electron.Radiate and kill the bacterium on apparatus and in container.Then will Apparatus after sterilization is stored in sterile chamber.Apparatus is kept sterile by the sealing container, should until being opened in medical facilities Untill container.

By reference in full or any patent, the patent that are partly incorporated herein are disclosed or other open materials only exist The material being incorporated in existing definition of the present invention, statement or the afoul scope of other open materials with not being incorporated to this Text.Thus, under necessary degree, the disclosure herein explicitly illustrated by replace be herein incorporated by reference it is any Afoul material.It is any be stated to be herein incorporated by reference but with it is as described herein it is existing definition, statement or other public affairs Open afoul any material of material or part thereof only will not produce punching between the material and existing open material being incorporated to It is incorporated herein under prominent degree.

Although being described the present invention as exemplary design, it is also possible in spirit and scope of the present disclosure It is interior that the present invention will be further modified.Therefore present patent application be intended to using its general principles any modification, Purposes or adaptive version.In addition, present patent application is intended to come from known in art of the present invention or is used to have practical framework The interior pattern away from the disclosure.

Claims (7)

1. a kind of nail bin, including：

Warehouse, the warehouse includes platform and the nail cavity being limited in the platform；

Nail, wherein each nail is positioned at least partially in one in the nail cavity, and wherein described nail can be Moved between non-firing position and firing position；

Compressible tissue thickness compensation part, wherein the nail is extended at least partly into the tissue thickness compensation part, and And wherein when the nail is moved between the non-firing position and the firing position, the nail can be caught at least in part Obtain the tissue thickness compensation part；And

Substrate, the substrate is positioned between the tissue thickness compensation part and the platform, wherein the substrate is including multiple Sealed tube, the sealed tube includes medicine.

2. nail bin according to claim 1, wherein the sealed tube is aligned with the nail.

3. nail bin according to claim 1, wherein the warehouse also includes that the slit of cutting element can be received, wherein institute Sealed tube is stated on the slit to extend, and wherein described sealed tube can be discharged wherein by cutting element cutting Comprising the medicine.

4. nail bin according to claim 3, wherein each sealed tube extends along pipe axis, and wherein every pipe axis exists Side transverse to the slit is upwardly extended.

5. nail bin according to claim 1, wherein the medicine includes fluid.

6. nail bin according to claim 1, wherein each include at least one nail leg in the nail,

Wherein described substrate includes some or all of multiple holes, and wherein described nail leg and extends through the hole.

7. nail bin according to claim 1, wherein the compressible Tissue compensating part is attached to the substrate.